studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 487A
Disclosures:
The following authors have nothing to disclose: Michelle T. Jesse, Reema Habra,
Steven Mekaru, Eric Goldstein, Anne Eshelman, Marwan S. Abouljoud
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Palliative Care Services are Underutilized in Liver Transplant
Candidates
Priya Kathpalia 1 , Alexander Smith 2 , Jennifer C. Lai 1 ; 1 Division of
Gastroenterology and Hepatology, University of California, San
Francisco, San Francisco, CA; 2 Division of Geriatrics, University of
California, San Francisco, San Francisco, CA
Background: Patients with end-stage liver disease (ESLD)
experience high symptom burden and 50% risk of death at
5 years from progressive liver disease without liver transplant
(LT). These patients represent a population with high needs
for palliative care. Utilization practices of palliative care of LT
candidates are not well characterized. Methods: All adult LT
candidates who died or were delisted from the wait-list at a
single high volume LT center from 2013-14 were evaluated.
Excluded were those who were delisted for noncompliance
or were transplanted at another center. Reasons for palliative
care consultation were obtained from review of electronic
health records. Logistic regression assessed factors associated
with palliative care consultation in these patients. Results: Of
683 patients listed for LT in 2013-14, 107 (16%) ultimately
died (n=62) or were delisted for being too sick for LT (n=45):
median age was 58 years, 34% were female, 53% were white,
61% had Child Pugh Class C cirrhosis, and 52% had hepatocellular
carcinoma. Among these 107 patients who died/were
delisted, 17% (n=18) received a palliative care consult, 89%
(16/18) of which occurred in the inpatient setting. The median
(interquartile range [IQR]) number of days from palliative care
consultation to death was 4 (1-11 days), with 50% of the consultations
occurring within 3 days of death. Reasons for palliative
care consultation were: assistance with transition to comfort
care (78%), goals of care without transition to comfort care
(11%) and symptom management (11%). Even among the 26
patients delisted for advanced HCC, only 12% were referred
to palliative care. In univariable analysis, age (OR 0.92; 95%
CI 0.87-0.98; p