title: Social determinants of orthotopic liver transplantation candidacy: role of patient-related factors.
abstract: BACKGROUND
  Eligibility for orthotopic liver transplantation (OLT) requires careful selection of the best possible candidate. The aim of this study was to identify factors associated with transplantation ineligibility.
  
  
  METHODS
  This was a retrospective cohort study of all patients evaluated for OLT at our center (2004-2006) and deemed not eligible. We identified all patients who were evaluated using information from our transplantation database. We extracted demographic data, insurance status, laboratory data, and clinical information including psychosocial evaluations.
  
  
  RESULTS
  During the study period 242 evaluated candidates were not listed for transplantation. The most common reason for ineligibility for transplantation listing was early referral (n=59; 24.4%), followed by psychosocial (18.6%), medical contraindications (17.3%), death during evaluation (n=32; 13.2%), malignancy (n=22; 9.1%), declined evaluation or transfer to other transplantation center (n=21; 8.7%), and other reasons (8.7%). In contrast to whites, psychosocial factors were the most common reason among African American candidates.
  
  
  CONCLUSIONS
  This study provides insight into factors contributing to OLT ineligibility among candidates of various ethnic backgrounds.
authors.affiliation: University of Cincinnati, Cincinnati, Ohio, USA. Nkemmer947@aol.com
authors.forename: N
authors.initials: N
authors.lastname: Kemmer
authors.forename: A
authors.initials: A
authors.lastname: Alsina
authors.forename: G W
authors.initials: GW
authors.lastname: Neff
mesh_terms: D001741:Black or African American; D004608:Eligibility Determination; D005431:Florida; D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000208:ethnology / Q000523:psychology*; D016015:Logistic Models; D008484:Medicaid; D016017:Odds Ratio; D018579:Patient Selection; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States; D014850:Waiting Lists; D044465:White People