Factors associated with regional disparities for registration on the French national liver transplantation waiting list

Abstract

This study compared the gap between supply and need for liver transplantation among the geographic regions of France. Supply was estimated by registration rates on the national waiting list and need by cirrhosis-related death rates. Hierarchical ascendant classification and principal component analysis were applied to identify regional patterns in the gap between supply and need. Associations between socio-ecodemographics and regional healthcare factors were investigated. We have found regional disparities between supply and need, mainly in regions with high rates of cirrhosis-related death. Among the 22 regions studied, six regional patterns were identified. The biggest gap between supply and need was found in regions characterized by the lack of a regional transplantation center or a low density of general and specialized practitioners. These regions were mainly rural or without a city with more than 200,000 inhabitants, and had high proportions of young people and lower social classes. The smallest gap between supply and need was found in regions presenting the opposite patterns. These results might be considered by health authorities when planning resource allocation for liver transplantation. Transplantation teams and their networks should strive for better geographical access before registration on the waiting list.