Proximity to transplant center and outcome among liver transplant patients

Research output: Contribution to journalArticlepeer-review

Authors

  • Gwilym J Webb
  • James Hodson
  • John O'Grady
  • James M Neuberger
  • James W Ferguson

Colleges, School and Institutes

External organisations

  • aNational Institute for Health Research, Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Queens Medical Centre Campus bInstitute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
  • National Institute for Health Research (NIHR), Birmingham Liver Biomedical Research Unit (BRU), and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom.
  • Statistics, Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, UK.
  • Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.

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.

Details

Original languageEnglish
JournalAmerican Journal of Transplantation
Early online date7 Jul 2018
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