Evolution of a Transplant Surgery Advanced Practice Provider Practice Model in the Care of High-Acuity Liver Transplant Recipients: A Single-Center Experience.

BACKGROUND: The role of advanced practice providers (APPs) in an academic transplant surgical acute care setting remains to be defined. We sought to evaluate the impact of a transplant surgeon-APP (TSAPP) practice model on patient access and outcomes in the care of critically ill patients with end-stage liver disease (ESLD) in an academic transplant center. METHODS: A retrospective analysis evaluated the effect of practice model evolution over an 11-year period on hospital access of patients with ESLD to an academic liver transplantation center and survival outcomes. We compared 3 practice models: era 1 (transplant surgeon-general surgery resident; January 2009 to Sept 2012): vs era 2 ( transition transplant surgeon-general surgery resident to TSAPP; October 2012 to December 2016): vs era 3 (TSAPP; January 2017 to December 2020). RESULTS: Patient access to hospitalization and inpatient service census increased significantly over time with TSAPP model (P < .01). At the time of liver transplant, the median Model for End-Stage Liver Disease scores for era 1 (25), era 2 (33), and era 3 (34), P < .01, and patient requirement for intensive care unit for era 1 (7.1%), era 2 (44.8%), and era 3 (56.4%), P < .01, have increased. The overall 1-year patient survival rates remained comparable across all eras: era 1 (93.88%), era 2 (93.11%), and era 3 (94.06%), P = .77 CONCLUSIONS: The APPs play an integral role in clinical transplantation practice. The integration of APPs into the transplant surgical workforce increased access of high-acuity patients with ESLD to the transplantation center. In addition, it provided excellent patient and graft survival outcomes after liver transplant.

De Novo Autoimmune Hepatitis after COVID-19 Infection in an Unvaccinated Patient.

Liver test abnormalities have been described during severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection causing coronavirus disease 2019. Most of them consist of elevation of the aminotransferases that resolve once the infection subsides. There are several reports of autoimmune hepatitis developing after vaccination against COVID-19 and one case of autoimmune hepatitis following COVID-19 infection. We present a patient that was not vaccinated against COVID-19 and developed resistant de novo autoimmune hepatitis following COVID-19 infection requiring aggressive immunosuppression.