Geographical Distance From Transplant Center and Impact on Waitlist Outcomes and Healthcare Utilization Prelisting

Area of Science:

• Hepatology
• Transplant Surgery
• Health Services Research

Background:

• Decompensated cirrhosis significantly reduces survival without liver transplantation (LT).
• Understanding factors influencing LT waitlist outcomes is critical.

Purpose of the Study:

• To investigate the impact of geographical distance from an LT center on waitlist mortality and LT receipt.
• To identify potential disparities in healthcare utilization based on distance.

Main Methods:

• Retrospective analysis of adult LT waitlisted patients (2012-2021) in London, Ontario.
• Stratification of patients based on distance to LT center (≤150 km vs >150 km).
• Multivariate time-to-event analyses to assess distance effects on mortality and LT receipt.

Main Results:

• Distance to LT center did not significantly affect LT receipt or waitlist mortality.
• Model for End-Stage Liver Disease-Sodium score at listing predicted increased waitlist mortality.
• Hepatocellular carcinoma diagnosis was associated with reduced waitlist mortality.
• Patients farther from the LT center showed higher pre-listing hospitalizations and ED visits.

Conclusions:

• Geographical distance is not a significant barrier to liver transplantation.
• Healthcare utilization patterns suggest potential pre-transplant disparities for patients living farther from LT centers.