Impact of digital hepatological network on the referrals of HCC patients: Preliminary results

Introduction and aim Hepatocellular carcinoma (HCC) is the most frequent liver tumor disease with an overall annual incidence of 2-4%. Its treatment must account for HCC features, liver function and comorbities, but often it's diagnosed in primary care units that lacks the facilities, the experties and the transplant assesment capability, to properly manage HCC. Referral to Hub centres assures best clinical outcomes, therefore according to AISF guidelines in dicember 2021 a network among primary and tertiary hepatological centres was set up in Veneto (REPAV). Methods We compared HCC referrals to our Hub centre for liver desease and patients trajectories in the first eight months of REPAV activity to the previous eight months. Results After REPAV set-up, 29.1% of all referrals were for new diagnosis of HCC (14/48). When compared to the prevoius 8 months, HCC referrals increased of 180% (5 vs. 14 patients) and both first hepathological visit and first locoregional treatment time decreased (8 days vs. 29 days, p=0.039, and 42 vs. 21 days, p=0.048 respectively). A significantly higher transplant activity was observed in post-network era: 10/14 vs. 1/5, +51.4%; among those, 3/10 were put on waiting list and 1/3 transplanted. As a result of the network referral acrivity 9 TACE/TAE on 5 patients were performed and 2 MW (+ 225% and +120%, respectively). Discussion The implementation of a digital hepatological network increased and improved HCC referrals, allowing a quicker and more effective accessibility to hub centre facilities, reducing appropriate treatment delivery wait-time. The network overcomes the inequity of distribution of facilities and makes tratment delivery more fair, as in AISF guidelines aims. Conclusion A matching network to AISF purposes of a reasonate clinical-assistential network model can significantly improve effectiveness in HCC treatment. The setup of digital referral networks should be encouraged everywhere to optimally manage HCC patients.