Proximity to transplant center and outcome among liver transplant patients

Gwilym J Webb, James Hodson, Abhishek Chauhan, John O'Grady, James M Neuberger, Gideon M Hirschfield, James W Ferguson

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)
121 Downloads (Pure)

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 × 107 (55.1%) reside ≥60 minutes from a center, and 7.65 × 106 (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.

Original languageEnglish
JournalAmerican Journal of Transplantation
Early online date7 Jul 2018
DOIs
Publication statusE-pub ahead of print - 7 Jul 2018

Keywords

  • 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

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