Recommendations for outpatient management of patients with decompensated cirrhosis, for liver transplant evaluations, and on a transplant waiting list during the COVID-19 pandemic

Clinic visits and consultations
  • Continue to prioritize in-person transplant evaluations for patients with hepatocellular carcinoma or severe disease and high MELD scores, who are likely to benefit from immediate liver transplant listing

    • Consider telemedicine or virtual alternatives for less urgent patients

    • Consider developing online education programs and avoid group sessions for patient education

  • Consider using a “COVID-19-free” path through the hospital for transplantation candidates

Laboratory testing and imaging
  • Obtain labs and imaging only if clinically necessary and do not update labs or imaging simply to update MELD score

  • Obtain SARS-CoV-2 testing for patients with new onset hepatic decompensation

  • Ensure refills are available for essential medications

  • Prescribe 90-day supplies instead of 30-day supplies

SARS-CoV-2 positive patients
  • Have a low threshold for hospitalizing patients on the transplant waiting list who develop COVID-19

General recommendations
  • Advise patients to avoid in-person community support group meetings and provide virtual alternatives

  • Advise patients to avoid travel during the pandemic

  • MELD = model for end-stage liver disease

  • Based on information from Fix, et al.1