Improved liver transplant waitlist mortality and lower risk of disease progression

Telemedicine Consult - Dr. Gish

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WHO:

Dr. Gish is a Hepatologist specializing in all forms of liver disease, liver cancer and liver transplant. Dr. Gish has partnered with TeleMed2U to provide telemedicine consultative services for patients with liver disease.

WHAT:

TeleMed2U is a telemedicine-based multi-specialty clinical practice increasing access to specialist providers providing, “healthcare anywhere and everywhere.” The telemedicine consultation will be conducted through our HIPAA and HITECH compliant platform. Connectivity testing will be done in advance to ensure you can connect via our telemedicine platform. Following the consultation, a clinical note will be provided including a summary of your liver consultation with Dr. Gish and his consultative recommendations.

COST:

Payment will be processed through an online secure transaction portal. The fees for consultative services are:

Initial 60 minute consultation per patient: $500.00
Follow Up 30 minute consultation per patient: $300.00

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If you’d like to continue, please click Next to complete the form and we will contact you to schedule connectivity testing. During the test you will have the opportunity to determine the method of providing medical records, discuss appointment availability as well as discuss any additional questions that you have. If you are a healthcare facility interested in services, please complete the form and we can discuss the options that are right for you and your patients.

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Improved liver transplant waitlist mortality and lower risk of disease progression

Feb 20, 2019

Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct-acting antiviral therapies in the United States

Direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection achieve high cure rates, reducing HCV-related disease progression to cirrhosis and hepatocellular carcinoma. We aim to evaluate the impact of DAAs on US liver transplant (LT) waitlist outcomes. We retrospectively evaluated US adults (age ≥18) with and without chronic HCV listed for LT before and after the widespread use of sofosbuvir, allowing a 6-month period after approval (Era 1: 1/1/2002-5/31/2014 vs Era 2: 6/1/2014-12/31/2016) using the United Network for Organ Sharing registry. Overall, LT waitlist survival and likelihood of receiving LT were evaluated with multivariate Cox regression models. From 2002 to 2016, 158 045 patients were listed for LT. While the number of patients listed for HCV has been decreasing since 2012, the proportion of HCV patients with concurrent HCC is increasing by 3.33% per year (R2: 0.99, P < 0.001 by simple linear regression). While there was no difference in likelihood of LT between HCV and non-HCV patients, those listed in Era 2 had lower likelihood of LT (HR: 0.91, P < 0.001), more pronounced in the HCV cohort (HR: 0.83, P < 0.001) compared to the non-HCV cohort (HR: 0.93, P < 0.001). Compared to non-HCV patients, higher waitlist mortality was seen in HCV patients in Era 1 (HR: 1.08, P < 0.001) but not in Era 2 (HR: 1.02, P = 0.75). Since the introduction of DAAs for HCV treatment, number of patients with HCV listed for LT has declined. In the post-DAA era, HCV patients on the LT waitlist had improved waitlist mortality.

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