Distance From Liver Transplant Centers Raises Healthcare Use
Patients living more than 150 km from a liver transplant center had similar waitlist mortality and transplant rates as those living closer but experienced more emergency room visits and hospital stays before and during their wait.
METHODOLOGY:
Researchers performed a population-based retrospective analysis of adult patients waitlisted for liver transplantation in Canada from January 1, 2012, to December 31, 2021, to assess whether distance to the transplant center influenced patient outcomes and healthcare utilization.
Patients were stratified into two groups based on whether they were living ≤ 150 km or > 150 km from a transplant center.
Data were linked to the Institute for Clinical Evaluative Sciences to evaluate waitlist mortality, receipt of liver transplantation, and healthcare utilization patterns (eg, emergency department visits and hospitalizations) before and after listing.
TAKEAWAY:
Of 552 analyzed patients (median age, 59 years; media distance from center, 110 km), 71.4% underwent liver transplantation.
Distance to the transplant center did not predict waitlist mortality or receipt of liver transplantation.
A higher sodium Model for End-Stage Liver Disease score at listing was significantly associated with increased waitlist mortality (hazard ratio [HR], 1.12; P < .01), whereas a diagnosis of hepatocellular carcinoma was linked to reduced waitlist mortality (HR, 0.13; P < .01).
Patients living more than 150 km away had more emergency department visits (median 3 vs 2; P < .01) and hospitalizations (median 2 vs 1; P = .02) in the year before listing. Although they also experienced a significantly greater median number of emergency department visits within 90 days of listing, these results were not significant.
IN PRACTICE:
'If healthcare utilization increases when LT [liver transplantation] candidates are farther from tertiary centers, the cost of this to patients and the system must be balanced with the potential benefit of solutions. For example, satellite assessment clinics have shown benefit in LT assessment in the UK and have significant utility for both patient and provider,' the authors wrote.
SOURCE:
The study was led by Mayur Brahmania, MD, University of Calgary Cumming School of Medicine in Calgary, Alberta, Canada. It was published online in The American Journal of Gastroenterology.
LIMITATIONS:
Distance was evaluated as a continuous variable, but statistical power was insufficient to identify a significant cutoff. Patients from other Canadian provinces were not included due to database limitations, potentially missing significant outcome differences in these populations.
DISCLOSURES:
This study was funded by the Multi-Organ Transplant Program as part of London Health Sciences Center Annual Research Grant. The authors reported having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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