Following the organ supply: Assessing the benefit of inteR-Dsa travel in liver transplantation

Nino Dzebisashvili, Allan B. Massie, Krista L. Lentine, Mark A. Schnitzler, Dorry Segev, Janet Tuttle-Newhall, Sommer Gentry, Richard Freeman, David A. Axelrod

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


BACKGROUND: Disparity in access to liver transplantation (LT) in the United States persists despite directives from the federal government to reduce geographic variation. We assessed the impact of socioeconomic status (SES) and traveling to alternative donation service areas (DSAs) on patient survival. METHODS: A prospective cohort study integrating transplant registry and U.S. Census data was analyzed using multivariate linear Cox proportional hazards models. A separate matched-pairs analysis was used to assess the benefit of traveling on patient survival and transplantation rate. RESULTS: High SES is associated with increased access to LT (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [95% CI], 1.01-1.08) and reduced mortality after waitlisting (aHR [95% CI], 0.88 [0.85-0.93]). Increased access is mediated, in part, through inter-DSA travel. Travel was associated with high SES, white race, blood group O, private insurance, and residence in regions 1, 5, and 11. Transplant candidates in the highest SES quartile were approximately 70% more likely to travel (aHR [95% CI], 1.67 [1.43-1.97]) than those in the lowest SES quartile. Compared with matched control patients, travelers were 74% more likely to be transplanted (aHR [95% CI], 1.74 [1.56-1.94]) and 20% less likely to die after listing (aHR [95% CI], 0.79 [0.69-0.92]). CONCLUSION: High SES and inter-DSA travel are strongly associated with increased LT access and reduced mortality. Travelers are more likely to be sociodemographically advantaged and privately insured and to live in regions with reduced access to deceased-donor organs.

Original languageEnglish (US)
Pages (from-to)361-371
Number of pages11
Issue number2
StatePublished - Jan 27 2013


  • Allocation policy
  • Geographic variation
  • Healthcare disparities
  • Liver transplantation
  • MELD.
  • Socioeconomic status

ASJC Scopus subject areas

  • Transplantation


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