Increased Distance to a Liver Transplant Center Is Associated With Higher Mortality for Patients With Chronic Liver Failure

Goldberg, David S.; Newcomb, Craig; Gilroy, Richard; Sahota, Gurvaneet; Wallace, Anna; Halpern, Scott D.

doi:10.1016/j.cgh.2017.02.023

Cited by 33 publications

(44 citation statements)

References 13 publications

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“…( 54‐56 ) A larger distance from a liver transplant center is associated with a higher likelihood of mortality and a lower likelihood of transplantation, ( 57,58 ) giving an advantage to individuals living in urban areas over more rural areas. ( 59 ) Given the dramatic expansion of telemedicine this year as a result of the COVID‐19 pandemic, it remains to be determined if increases in the use of telemedicine will impact intraregional transplant disparities by increasing access to patients living in rural areas.…”

Section: Geographic Disparitiesmentioning

confidence: 99%

A Review of the Current State of Liver Transplantation Disparities

2021

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Equity in access is one of the core goals of the Organ Procurement and Transplant Network (OPTN). However, disparities in liver transplantation have been described since the passage of the National Organ Transplant Act, which established OPTN in the 1980s. During the past few decades, several efforts have been made by the United Network for Organ Sharing (UNOS) to address disparities in liver transplantation with notable improvements in many areas. Nonetheless, disparities have persisted across insurance type, sex, race/ethnicity, geographic area, and age. African Americans have lower rates of referral to transplant centers, females have lower rates of transplantation from the liver waiting list than males, and public insurance is associated with worse posttransplant outcomes than private insurance. In addition, pediatric candidates and older adults have a disadvantage on the liver transplant waiting list, and there are widespread regional disparities in transplantation. Given the large degree of inequity in liver transplantation, there is a tremendous need for studies to propose and model policy changes that may make the liver transplant system more just and equitable.

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Section: Geographic Disparitiesmentioning

confidence: 99%

A Review of the Current State of Liver Transplantation Disparities

2021

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“…[25][26][27] Although the majority of patients with chronic liver failure do not undergo a liver transplant, proximity to such a center has been associated with decreased mortality, presumably due to access to specialized care. 28 We can infer from the literature and the results of this study that patients with EGS-LD are best served at specialty centers that have access to higherlevel care through a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 91%

Understanding Health Care Utilization and Mortality After Emergency General Surgery in Patients With Underlying Liver Disease

Tennakoon

Baiu

Concepción

et al. 2020

The American Surgeon™

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Background Mortality and complications are not well defined nationally for emergency general surgery (EGS) patients presenting with underlying all-cause liver disease (LD). Study design We analyzed the 2012-2014 National Inpatient Sample for adults (aged ≥ 18 years) with a primary EGS diagnosis. Underlying LD included International Classification of Diseases, Ninth Revision, Clinical Modification codes for alcoholic and viral hepatitis, malignancy, congenital etiologies, and cirrhosis. The primary outcome was mortality; secondary outcomes included complications, operative intervention, and costs. Results Of the 6.8 million EGS patients, 358 766 (5.3%) had underlying LD. 59.1% had cirrhosis, 6.7% had portal hypertension, and 13.7% had ascites. Compared with other EGS patients, EGS-LD patients had higher mean costs ($12 847 vs $10 234, P < .001). EGS-LD patients were less likely to have surgery (26.1% vs 37.0%, P < .001) but for those who did, mortality was higher (4.8% vs 1.8%, P < .001). Risk factors for mortality included ascites (adjusted odds ratio [aOR] = 2.68, P < .001), dialysis (aOR = 3.44, P < .001), sepsis (aOR = 8.97, P < .001), and respiratory failure requiring intubation (aOR = 10.40, P < .001). Odds of death increased in both surgical (aOR = 4.93, P < .001) and non-surgical EGS-LD patients (aOR = 2.56, P < .001). Conclusions Underlying all-cause LD among EGS patients is associated with increased in-hospital mortality, even in the absence of surgical intervention.

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“…Limited access to gastroenterology/hepatology for liver disease management while on the wait list is believed to decrease overall survival. 5 One study estimated patients living greater than 30 miles from transplant centers have a 49 per cent increase in poor outcomes. 2 This is particularly relevant in our study because our medical center is the only facility in the state to offer liver transplant services.…”

Section: Discussionmentioning

confidence: 99%

One Hundred Fifty Liver Transplants at a New Program in the Modern Era: The University of Mississippi Experience

Curtis

Anderson

Seawright

et al. 2019

The American Surgeon™

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From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49–63]. BMI at transplant was 30 [IQR 25–35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19–21] and MELD-Na was 22 [95% confidence interval 20–23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.

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Increased Distance to a Liver Transplant Center Is Associated With Higher Mortality for Patients With Chronic Liver Failure

Cited by 33 publications

References 13 publications

A Review of the Current State of Liver Transplantation Disparities

A Review of the Current State of Liver Transplantation Disparities

Understanding Health Care Utilization and Mortality After Emergency General Surgery in Patients With Underlying Liver Disease

One Hundred Fifty Liver Transplants at a New Program in the Modern Era: The University of Mississippi Experience

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