Variation in access to the liver transplant waiting list in the United States

Amit Mathur, Valarie B. Ashby, Douglas S. Fuller, Min Zhang, Robert M. Merion, Alan Leichtman, John Kalbfleisch

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: We sought to compare liver transplant waiting list access by demographics and geography relative to the pool of potential liver transplant candidates across the United States using a novel metric of access to care, termed a liver wait-listing ratio (LWR). METHODS: We calculated LWRs from national liver transplant registration data and liver mortality data from the Scientific Registry of Transplant Recipients and the National Center for Healthcare Statistics from 1999 to 2006 to identify variation by diagnosis, demographics, geography, and era. RESULTS: Among patients with ALF and CLF, African Americans had significantly lower access to the waiting list compared with whites (acute: 0.201 versus 0.280; pre-MELD 0.201 versus 0.290; MELD era: 0.201 versus 0.274; all, P<0.0001) (chronic: 0.084 versus 0.163; pre-MELD 0.085 versus 0.179; MELD 0.084 versus 0.154; all, P<0.0001). Hispanics and whites had similar LWR in both eras (both P>0.05). In the MELD era, female subjects had greater access to the waiting list compared with male subjects (acute: 0.428 versus 0.154; chronic: 0.158 versus 0.140; all, P<0.0001). LWRs varied by three-fold by state (pre-MELD acute: 0.122-0.418, chronic: 0.092-0.247; MELD acute: 0.121-0.428, chronic: 0.092-0.243). CONCLUSIONS: The marked inequity in early access to liver transplantation underscores the need for local and national policy initiatives to affect this disparity.

Original languageEnglish (US)
Pages (from-to)94-99
Number of pages6
JournalTransplantation
Volume98
Issue number1
DOIs
StatePublished - Jul 15 2014
Externally publishedYes

Fingerprint

Waiting Lists
Transplants
Liver
Geography
Demography
African Americans
Liver Transplantation
Registries
Delivery of Health Care
Mortality

Keywords

  • Access to transplantation
  • Health services
  • Organ allocation

ASJC Scopus subject areas

  • Transplantation

Cite this

Mathur, A., Ashby, V. B., Fuller, D. S., Zhang, M., Merion, R. M., Leichtman, A., & Kalbfleisch, J. (2014). Variation in access to the liver transplant waiting list in the United States. Transplantation, 98(1), 94-99. https://doi.org/10.1097/01.TP.0000443223.89831.85

Variation in access to the liver transplant waiting list in the United States. / Mathur, Amit; Ashby, Valarie B.; Fuller, Douglas S.; Zhang, Min; Merion, Robert M.; Leichtman, Alan; Kalbfleisch, John.

In: Transplantation, Vol. 98, No. 1, 15.07.2014, p. 94-99.

Research output: Contribution to journalArticle

Mathur, A, Ashby, VB, Fuller, DS, Zhang, M, Merion, RM, Leichtman, A & Kalbfleisch, J 2014, 'Variation in access to the liver transplant waiting list in the United States', Transplantation, vol. 98, no. 1, pp. 94-99. https://doi.org/10.1097/01.TP.0000443223.89831.85
Mathur, Amit ; Ashby, Valarie B. ; Fuller, Douglas S. ; Zhang, Min ; Merion, Robert M. ; Leichtman, Alan ; Kalbfleisch, John. / Variation in access to the liver transplant waiting list in the United States. In: Transplantation. 2014 ; Vol. 98, No. 1. pp. 94-99.
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AB - BACKGROUND: We sought to compare liver transplant waiting list access by demographics and geography relative to the pool of potential liver transplant candidates across the United States using a novel metric of access to care, termed a liver wait-listing ratio (LWR). METHODS: We calculated LWRs from national liver transplant registration data and liver mortality data from the Scientific Registry of Transplant Recipients and the National Center for Healthcare Statistics from 1999 to 2006 to identify variation by diagnosis, demographics, geography, and era. RESULTS: Among patients with ALF and CLF, African Americans had significantly lower access to the waiting list compared with whites (acute: 0.201 versus 0.280; pre-MELD 0.201 versus 0.290; MELD era: 0.201 versus 0.274; all, P<0.0001) (chronic: 0.084 versus 0.163; pre-MELD 0.085 versus 0.179; MELD 0.084 versus 0.154; all, P<0.0001). Hispanics and whites had similar LWR in both eras (both P>0.05). In the MELD era, female subjects had greater access to the waiting list compared with male subjects (acute: 0.428 versus 0.154; chronic: 0.158 versus 0.140; all, P<0.0001). LWRs varied by three-fold by state (pre-MELD acute: 0.122-0.418, chronic: 0.092-0.247; MELD acute: 0.121-0.428, chronic: 0.092-0.243). CONCLUSIONS: The marked inequity in early access to liver transplantation underscores the need for local and national policy initiatives to affect this disparity.

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