Longer Liver Transplant Waiting Lists Associated With Sicker Patients in Donor Service Areas.

Abstract

BACKGROUND: Listing rates for liver transplantation vary significantly from one DSA to another on a per capita basis. We hypothesized that differences in disease prevalence and listing practices might contribute. METHODS: Data on patients listed for liver transplantation was obtained from the SRTR Standard Analysis File. Prevalence of end stage liver disease (ESLD) was estimated by the sum of liver transplants plus liver disease-related deaths from Centers for Disease Control death files. Population data was obtained from the US Census. RESULTS: DSA listing rates per 100 ESLD ranged from 1.3 to 14. Higher listing rates were associated with more transplant centers per DSA (P = 0.02) and more transplant centers per ESLD (P = 0.0006). There was no association with number of transplant centers per 100 liver transplants (P = 0.06) or MELD at transplant (P = 0.49). Higher listing rates were also associated with a greater percentage of candidates with age over 65 (OR 1.06, P < 0.0001), chronic obstructive pulmonary disease (OR 1.06, P = 0.0003), cardiovascular disease (OR 1.06, P < 0.0001), previous malignancy (OR 1.03, P < 0.0001), and BMI > 40 (OR 1.05, P < 0.0001). Higher listing rates were associated with lower percentage of candidates with portal vein thrombosis (OR 0.96, P=0.0007) and serum sodium<=120 (OR 0.94, P = 0.03). CONCLUSIONS: Higher listing rates are associated with more transplant centers per DSA and per capita, but not with MELD at transplant. Higher listing rates were associated with wait list candidates with older age and additional comorbidities, suggesting that a higher density of transplant centers may be associated with greater access to care for patients with ESLD.