Proximity to transplant center and outcome among liver transplant patients. Issue 1 (3rd August 2018)

• Record Type: Journal Article
• Authors: Webb, Gwilym J.; Hodson, James; Chauhan, Abhishek; O'Grady, John; Neuberger, James M.; Hirschfield, Gideon M.; Ferguson, James W.
• Is Part Of: American journal of transplantation. Volume 19:Issue 1(2019)
• Page Start: 208
• Page End: 220
• Publication Date: 2018-08-03
• Subjects: business / management -- clinical research / practice -- disparities -- health services and outcomes research -- informatics -- liver disease -- liver transplantation / hepatology -- organ transplantation in general -- patient characteristics -- patient referral; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15004
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : In the United States, distance from liver transplant center correlates with worsened outcomes; the effects of geography elsewhere are unassessed. We performed a national registry analysis of United Kingdom listings for liver transplantation (1995‐2014) and assessed whether travel time to transplant center correlates with outcome. There were 11 188 listings assessed (8490 transplanted), with a median travel time to center of 60 minutes (range 36‐86). Of the national population, 3.38 × 10 7 (55.1%) reside ≥60 minutes from a center, and 7.65 × 10 6 (12.5%) >119 minutes. After competing risk analysis, increasing travel time was associated with an increased risk of death after listing (subdistribution hazard ratios relative to <60 minutes of 1.33 for 60‐119 and 1.27 for >119 minutes; P < 0.001) and reduced likelihood of transplantation or recovery (0.94 and 0.86; P < 0.001). Among those transplanted, travel time was not associated with retransplant‐free survival ( P = 0.532). We used our model to examine optimal placement of a new center and identify a single site with a total travel time reduction of ≈10%. Our findings of disparities in accessibility of liver transplantation showed worse outcomes following listing in those distant from their transplant center, and our description of a method to model a new center complement existing data and support similar analyses of other networks. Abstract : This analysis demonstrates worse outcomes for UK patients listed for liver transplantation who live further from a transplant center, describes the current geography of the UK transplant population, and models the optimal position for an additional center to reduce access inequality. Hanto and Ladin's editorial is onpage 13 .