Kids Who Live Far from Liver Transplant Centers More Likely to Die Waiting for Organ

Geography matters in getting a liver transplant. There is an ongoing debate about whether to re-district the boundaries used in setting up organ donor/transplant regions and whether that would make the distribution system fairer.

Reporting at the Liver Meeting (AASLD) in San Francisco, CA, Joel Adler, MD of Massachussetts General Hospital in Boston, MA, looked at whether children on waitlists for donor livers are at a disadvantage if they live far from a transplant center.

Adler and colleagues looked at the Scientific Registry of Transplant Recipients and focused on pediatric liver transplant registrants from 2003 to 2012. He calculated the distance to each patient's nearest transplant center.

He found that in 6924 cases, the median distance to a center was 65 miles.

While traveling a longer distance to a center was not associated with spending more time on a waiting list, it was associated with a higher risk of a child dying while on that list. The hazard ratio was 1.7 for such patients.

The researchers adjusted for demographic factors, rural/urban status, and Pediatric End Stage Liver Disease score, a measure of how sick the child was.

His conclusion was that the increased risk of death in patients who live relatively far away from a center is likely due to "decreased access to specialist and tertiary care associated with a transplant center."

"These relationships deserve further consideration," Adler wrote in an abstract presented at the conference.