title: Patterns and Outcomes Associated with Patient Migration for Liver Transplantation in the United States.
abstract: BACKGROUND
  Traveling to seek specialized care such as liver transplantation (LT) is a reality in the United States. Patient migration has been attributed to organ availability. The aims of this study were to delineate patterns of patient migration and outcomes after LT.
  
  
  METHODS
  All deceased donor LT between 2008-2013 were extracted from UNOS data. Migrated patients were defined as those patients who underwent LT at a center in a different UNOS region from the region in which they resided and traveled a distance > 100 miles.
  
  
  RESULTS
  Migrated patients comprised 8.2% of 28,700 LT performed. Efflux and influx of patients were observed in all 11 UNOS regions. Regions 1, 5, 6, and 9 had a net efflux, while regions 2, 3, 4, 7, 10, and 11 had a net influx of patients. After multivariate adjustment for donor and recipient factors, graft (p = 0.68) and patient survival (p = 0.52) were similar between migrated and non-migrated patients.
  
  
  CONCLUSIONS
  A significant number of patients migrated in patterns that could not be explained alone by regional variations in MELD score and wait time. Migration may be a complex interplay of factors including referral patterns, specialized services at centers of excellence and patient preference.
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Croome
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: David D
authors.initials: DD
authors.lastname: Lee
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Burns
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Perry
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000628:therapy*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D014195:Travel / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States