ArticleUnited European gastroenterology journal2024
The role of an integrated referral program for patients with liver disease: A network between hub and spoke centers.
Article in United European gastroenterology journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 5 citations in OpenAlex.
- Reduced wait times for hepatology referrals in a prospective quality improvement initiative.Hepatology communications · 2026Article
- Decline in Complications and Mortality in Chronic Liver Disease and Cirrhosis: A Population-Based Cohort Study From Northeastern Italy.United European gastroenterology journal · 2025Article
- At the earliest: a Hub and Spoke referral and referral-back pilot project increases access to liver transplantation and ensures good long-term care.Updates in surgery · 2025Article
- Referral to Liver Transplant: A National Survey from Portugal.GE Portuguese journal of gastroenterology · 2025Article
- Trans-splenic anterograde coil-assisted transvenous occlusion (TACATO) of bleeding gastric varices associated with gastrorenal shunts in cirrhosis.JHEP reports : innovation in hepatology · 2025Article
- The role of an integrated referral program for patients with liver disease: A network between hub and spoke centers.United European gastroenterology journal · 2024Article
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Authors and funding
17 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
introductionAccess to Liver transplantation (LT) can be affected by several barriers, resulting in delayed referral and increased risk of mortality due to complications of the underlying liver disease.
aimTo assess the clinical characteristics and outcomes of patients with acute or chronic liver disease referred using an integrated referral program. MATERIALS AND
methodsAn integrated referral program was developed in 1 October 2017 based on email addresses and a 24/7 telephone availability. All consecutive adult patients with liver disease referred for the first time using this referral program were prospectively collected until 1 October 2021. Characteristics and outcomes of inpatients were compared with a historical cohort of patients referred without using the integrated referral program (1 October 2015-1 October 2017). Patients were further divided according to pre- and post-Covid-19 pandemic.
resultsTwo hundred eighty-one referred patients were considered. End stage liver disease was the most common underlying condition (79.3%), 50.5% of patients were referred as inpatients and 74.7% were referred for LT evaluation. When inpatient referrals (n = 142) were compared with the historical cohort (n = 86), a significant increase in acute liver injury due to drugs/herbals and supplements was seen (p = 0.01) as well as an increase in End stage liver disease due to alcohol-related liver disease and NASH, although not statistically significant. A significant increase in referrals for evaluation for Trans-jugular intrahepatic portosystemic shunt placement was seen over time (5.6% vs. 1%; p = 0.01) as well as for LT evaluation (84.5% vs. 81%; p = 0.01). Transplant-free survival was similar between the study and control groups (p = 0.3). The Covid-19 pandemic did not affect trends of referrals and patient survival.
conclusionsThe development of an integrated referral program for patients with liver disease can represent the first step to standardize already existing referral networks between hub and spoke centers. Future studies should focus on the timing of referral according to different etiologies to optimize treatment options and outcomes.
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