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

Orthotopic liver transplantation is the definitive treatment for end-stage liver disease. However, access to transplantation and post-transplant outcomes are influenced by multiple factors, including geographic proximity to transplant centers. Increased travel distance poses logistical barriers to care and has a greater impact on post-transplant morbidity. At our center, our protocol requires all transplant recipients to stay within proximity for 6-wk postoperatively, ensuring intensive follow-up and early complication management. This study evaluates whether outcomes vary by travel distance and whether our 6-wk proximity policy is associated with those patterns.

This retrospective single-center study (2018-2023) included adult liver transplant recipients within a 6-y period. Patients were stratified into three distance-based groups based on geodesic distance from their zip code centroid to the transplant center (< 50.0 miles, 50.0-150.0 miles, > 150.0 miles) to examine the association between geographic proximity and post-transplant outcomes. The primary outcomes were post-transplant complications, 30-d unplanned readmission, graft failure, and patient survival within one-year.

A total of 282 adult liver transplant recipients were included, with a median age of 52 y (interquartile range: 41-62) and a median travel distance of 147.7 miles. One-year mortality was significantly higher in patients living 50.1-100 miles from the transplant center (17.1%) compared to those in the < 50.0 miles (7.3%) and > 150.0 miles (5.3%) groups (P = 0.04). Multivariable regression analysis, adjusting for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, insurance type, employment status, Social Vulnerability Index, Model for End-Stage Liver Disease score, and etiology of liver disease, indicated that travel distance was not significantly associated with post-transplant complications (odds ratio 0.64, 95% confidence interval 0.24-1.70, P = 0.37).

Distance to the transplant center was not associated with increased post-transplant morbidity. Institutional protocols, including structured education and mandatory post-transplant stay in proximity to the center, may help explain the lack of observed associated with distance; however, causality cannot be inferred.