Challenging the Distance-Morbidity Paradigm Following Liver Transplantation: A Single Center Experience

Area of Science:

• Hepatology
• Transplant Surgery
• Public Health

Background:

• Orthotopic liver transplantation is a vital treatment for end-stage liver disease.
• Geographic proximity to transplant centers impacts access and post-transplant outcomes.
• Increased travel distance presents logistical challenges and may worsen post-transplant morbidity.

Purpose of the Study:

• To evaluate if post-transplant outcomes vary by travel distance to the transplant center.
• To assess the association between a 6-week proximity policy and transplant outcomes.
• To identify factors influencing liver transplant success in relation to patient location.

Main Methods:

• Retrospective single-center study of adult liver transplant recipients (2018-2023).
• Patients stratified into three groups based on geodesic distance (<50, 50-150, >150 miles).
• Primary outcomes included post-transplant complications, 30-day readmission, graft failure, and 1-year survival.

Main Results:

• Median travel distance was 147.7 miles for 282 recipients.
• One-year mortality was higher for patients 50.1-100 miles away (17.1%) vs. <50 miles (7.3%) and >150 miles (5.3%) (P=0.04).
• Travel distance was not significantly associated with post-transplant complications after multivariable adjustment (OR 0.64, P=0.37).

Conclusions:

• Geographic distance to the transplant center was not linked to increased post-transplant morbidity.
• Institutional protocols, including mandatory proximity and structured education, may mitigate distance-related disparities.
• While distance was not a significant factor, causality cannot be definitively inferred.