Orthotopic Liver Transplantation in a Multiethnic Population: Role of Spatial Accessibility

• Published in: Transplantation proceedings 2011-12, Vol.43 (10), p.3780-3782
• Main Authors: Kemmer, N, Alsina, A, Neff, G.W
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Aged; Biological and medical sciences; Chi-Square Distribution; European Continental Ancestry Group - statistics & numerical data; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - ethnology; Humans; Insurance, Health - statistics & numerical data; Liver Diseases - diagnosis; Liver Diseases - ethnology; Liver Diseases - surgery; Liver Transplantation - ethnology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Odds Ratio; Ohio - epidemiology; Referral and Consultation - statistics & numerical data; Residence Characteristics - statistics & numerical data; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.09.041

Abstract Introduction Access to orthotopic liver transplantation (OLT) varies among different ethnic groups. The aim of this study was to determine if distance from transplantation center (DT) impedes referral pattern and accessibility to OLT among ethnic groups. Method This is a retrospective cohort study of all patients evaluated for OLT at our center (2002–2007). The ZipCode Basic software was used to compute distance between the candidate's residence and transplantation center. Results Five hundred one patients were evaluated during the study period and there were 439 (87.6%) whites 43 (8.6%) African Americans (AA), and others (3.8%). The median DT was 36.8 miles (range, 0.5–231), and there was no significant correlation with the Model for End-Stage Liver Disease (MELD) at presentation ( P = .87). Although AA had a higher likelihood of residing closer to a transplantation center they were more likely to have a higher MELD at presentation (20 vs 15.4; P < .001) and less likely to be referred early to initiate OLT evaluation (11.6% vs 26.4%; P = .04). Additionally, type of insurance correlated with higher MELD at presentation. Conclusion DT was not a contributory factor to the observed access disparity in our patient population, rather the insurance type and disease severity as determined using MELD differed significantly among ethnic groups.