Geographical disparities for liver transplantation access in Mexico

Liver disease is a major cause of mortality in Mexico. Liver transplantation (LT) remains severely limited, and there are no reports on equity of access.

To analyze geographical disparities in LT access in Mexico.

LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed. LT listings per million persons (pmp) were calculated. Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000. LT and waitlist mortality was calculated as 90-day rate, overall rate and rate per 100 person-years. We compared access to waitlist, transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.

There were 2600 new waitlist registrations; 1572 registrations (60.4%) living in Mexico City and State, Jalisco and Nuevo Leon. There were 1755 LT; 92.5% of them performed in States with higher LT activity, and 1101 (62.7% vs 37.3%; P < 0.001) done in patients living in those States. Listings pmp in the Mexican States with high LT activity were 3.8, 1.5 vs 1.2, 0.6 (P < 0.001); observed-to-expected listings were 1.3, 0.4 vs 0.4, 0.2 (P < 0.001); LT pmp were 2.7, 0.9 vs 0.7, 0.5 (P < 0.001). After controlling for other variables, patients living in high LT activity States had a HR 1.14 (95%CI: 1.03-1.26; P = 0.009) to be a case of transplantation after listing.

Geographic disparities substantially affect LT access in Mexico. The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT. Current referral system, and resource allocation need urgent revision to remove the barriers associated with geographic disparity.