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Proximity to transplant center and outcome among liver transplant patients
Author(s) -
Webb Gwilym J.,
Hodson James,
Chauhan Abhishek,
O’Grady John,
Neuberger James M.,
Hirschfield Gideon M.,
Ferguson James W.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15004
Subject(s) - medicine , liver transplantation , single center , transplantation , hazard ratio , population , united network for organ sharing , emergency medicine , surgery , confidence interval , demography , environmental health , sociology
In the United States, distance from liver transplant center correlates with worsened outcomes; the effects of geography elsewhere are unassessed. We performed a national registry analysis of United Kingdom listings for liver transplantation (1995‐2014) and assessed whether travel time to transplant center correlates with outcome. There were 11 188 listings assessed (8490 transplanted), with a median travel time to center of 60 minutes (range 36‐86). Of the national population, 3.38 × 10 7 (55.1%) reside ≥60 minutes from a center, and 7.65 × 10 6 (12.5%) >119 minutes. After competing risk analysis, increasing travel time was associated with an increased risk of death after listing (subdistribution hazard ratios relative to <60 minutes of 1.33 for 60‐119 and 1.27 for >119 minutes; P < 0.001) and reduced likelihood of transplantation or recovery (0.94 and 0.86; P < 0.001). Among those transplanted, travel time was not associated with retransplant‐free survival ( P = 0.532). We used our model to examine optimal placement of a new center and identify a single site with a total travel time reduction of ≈10%. Our findings of disparities in accessibility of liver transplantation showed worse outcomes following listing in those distant from their transplant center, and our description of a method to model a new center complement existing data and support similar analyses of other networks.