Identifying and understanding variation in population-based access to liver transplantation in the United States

Katie Ross-Driscoll; Jonathan Gunasti; Arrey-Takor Ayuk-Arrey; Joel T Adler; David Axelrod; Lisa McElroy; Rachel E Patzer; Raymond Lynch

doi:10.1016/j.ajt.2023.06.002

Identifying and understanding variation in population-based access to liver transplantation in the United States

Am J Transplant. 2023 Sep;23(9):1401-1410. doi: 10.1016/j.ajt.2023.06.002. Epub 2023 Jun 10.

Authors

Katie Ross-Driscoll¹, Jonathan Gunasti², Arrey-Takor Ayuk-Arrey³, Joel T Adler⁴, David Axelrod⁵, Lisa McElroy⁶, Rachel E Patzer⁷, Raymond Lynch²

Affiliations

¹ Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: [email protected].
² Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.
³ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.
⁴ Division of Abdominal Transplantation, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA.
⁵ Solid Organ Transplant Center, Department of Surgery, University of Iowa, Iowa City, Iowa, USA.
⁶ Division of Abdominal Transplantation, Department of Surgery and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
⁷ Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Abstract

We aimed to identify variations in liver transplant access across transplant referral regions (TRRs), accounting for differences in population characteristics and practice environments. Adult end-stage liver disease (ESLD) deaths and liver waitlist additions from 2015 to 2019 were included. The primary outcome was listing-to-death ratio (LDR). We modeled the LDR as a continuous variable and obtained adjusted LDR estimates for each TRR, accounting for clinical and demographic characteristics of ESLD decedents, socioeconomic and health care environment within the TRR, and characteristics of the transplant environment. The overall mean LDR was 0.24 (range: 0.10-0.53). In the final model, proportion of patients living in poverty and concentrated poverty was negatively associated with LDR; organ donation rate was positively associated with LDR. The R² was 0.60, indicating that 60% of the variability in LDR was explained by the model. Approximately 40% of this variation remained unexplained and may be due to transplant center behaviors amenable to intervention to improve access to care for patients with ESLD.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
End Stage Liver Disease* / epidemiology
End Stage Liver Disease* / surgery
Humans
Liver Transplantation*
Retrospective Studies
Tissue and Organ Procurement*
United States / epidemiology
Waiting Lists

Abstract

Publication types

MeSH terms

Grants and funding