Geographical disparities for liver transplantation access in Mexico

Area of Science:

• Hepatology
• Transplant Surgery
• Public Health Policy

Background:

• Liver disease is a leading cause of mortality in Mexico.
• Liver transplantation (LT) is severely limited, with no prior reports on access equity.
• Analysis of geographical disparities in LT access is crucial.

Purpose of the Study:

• To investigate geographical disparities in liver transplantation (LT) access within Mexico.
• To assess the impact of patient location on LT waitlist and transplantation rates.

Main Methods:

• Evaluated LT waitlist registrations and LT rates in Mexico (2014-2023).
• Calculated LT listings per million persons (pmp) and observed-to-expected listings.
• Compared waitlist access, transplantation rates, and mortality between patients in high-LT activity states and others.

Main Results:

• 60.4% of waitlist registrations and 92.5% of LTs occurred in high-LT activity states.
• High-LT activity states showed significantly higher listings pmp (3.8 vs 1.2) and LT pmp (2.7 vs 0.7).
• Patients in high LT activity states had a 1.14-fold higher likelihood of transplantation after listing (HR 1.14; P=0.009).

Conclusions:

• Substantial geographical disparities exist in LT access in Mexico.
• Proximity to Transplant Centers significantly increases waitlist access (3.2-fold) and LT likelihood (3.8-fold).
• Urgent revision of referral systems and resource allocation is needed to address geographic barriers.