TY - JOUR
T1 - Identifying and understanding variation in population-based access to liver transplantation in the United States
AU - Ross-Driscoll, Katie
AU - Gunasti, Jonathan
AU - Ayuk-Arrey, Arrey Takor
AU - Adler, Joel T.
AU - Axelrod, David
AU - McElroy, Lisa
AU - Patzer, Rachel E.
AU - Lynch, Raymond
N1 - Publisher Copyright:
© 2023 American Society of Transplantation & American Society of Transplant Surgeons
PY - 2023/9
Y1 - 2023/9
N2 - We aimed to identify variations in liver transplant access across transplant referral regions (TRRs), accounting for differences in population characteristics and practice environments. Adult end-stage liver disease (ESLD) deaths and liver waitlist additions from 2015 to 2019 were included. The primary outcome was listing-to-death ratio (LDR). We modeled the LDR as a continuous variable and obtained adjusted LDR estimates for each TRR, accounting for clinical and demographic characteristics of ESLD decedents, socioeconomic and health care environment within the TRR, and characteristics of the transplant environment. The overall mean LDR was 0.24 (range: 0.10-0.53). In the final model, proportion of patients living in poverty and concentrated poverty was negatively associated with LDR; organ donation rate was positively associated with LDR. The R2 was 0.60, indicating that 60% of the variability in LDR was explained by the model. Approximately 40% of this variation remained unexplained and may be due to transplant center behaviors amenable to intervention to improve access to care for patients with ESLD.
AB - We aimed to identify variations in liver transplant access across transplant referral regions (TRRs), accounting for differences in population characteristics and practice environments. Adult end-stage liver disease (ESLD) deaths and liver waitlist additions from 2015 to 2019 were included. The primary outcome was listing-to-death ratio (LDR). We modeled the LDR as a continuous variable and obtained adjusted LDR estimates for each TRR, accounting for clinical and demographic characteristics of ESLD decedents, socioeconomic and health care environment within the TRR, and characteristics of the transplant environment. The overall mean LDR was 0.24 (range: 0.10-0.53). In the final model, proportion of patients living in poverty and concentrated poverty was negatively associated with LDR; organ donation rate was positively associated with LDR. The R2 was 0.60, indicating that 60% of the variability in LDR was explained by the model. Approximately 40% of this variation remained unexplained and may be due to transplant center behaviors amenable to intervention to improve access to care for patients with ESLD.
KW - Adult
KW - End Stage Liver Disease/surgery
KW - Humans
KW - Liver Transplantation
KW - Retrospective Studies
KW - Tissue and Organ Procurement
KW - United States/epidemiology
KW - Waiting Lists
UR - http://www.scopus.com/inward/record.url?scp=85164190317&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85164190317&partnerID=8YFLogxK
U2 - 10.1016/j.ajt.2023.06.002
DO - 10.1016/j.ajt.2023.06.002
M3 - Article
C2 - 37302576
AN - SCOPUS:85164190317
SN - 1600-6135
VL - 23
SP - 1401
EP - 1410
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 9
ER -