title: Increased Risk of Death for Patients on the Waitlist for Liver Transplant Residing at Greater Distance From Specialized Liver Transplant Centers in the United States.
abstract: We have previously shown that patients listed for orthotopic liver transplantation (OLT) in United Network for Organ Sharing Region 4 (Texas and Oklahoma) have higher waitlist mortality rates when residing more than 30 miles from specialized liver transplant centers (LTC). Considering that findings might only be exclusive for this region with its peculiarities in terms of having the highest land surface extensions, lowest population densities, and largest rural populations. We investigated the entire OLT patient population in the United States to assess if our previous regional findings are nationally validated and if a rural, micropolitan, or metropolitan residence location affects outcome of waitlisted OLT patients in the nation.
  
  
  
  Patients waiting for OLT in the United States from 2002 to 2012 were stratified by distance from the patients' residence to LTC and by Rural Urban Commuting Area (RUCA) codes classification. Statistical analyses were performed to evaluate risk of mortality on the waitlist and the likelihood to receive an OLT using a Cox proportional hazards model and a generalized additive model with a logistic link.
  
  
  
  Survival time and probability of death while on the waitlist for OLT using distance to LTC showed significant increased risk with the distance (P = 0.001 and P < 0.0001, respectively). At the same time, using RUCA classification as the variable did not show significance (P = 0.14 and P = 0.73, respectively).
  
  
  
  Distance from an LTC is a risk factor of mortality on the waitlist for OLT, whereas RUCA classification is not a significant factor.
authors.affiliation: 1 University of Texas Medical Branch, Department of Surgery, Department of Surgery, Texas Transplant Center, Galveston, TX. 2 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
authors.forename: Luca
authors.initials: L
authors.lastname: Cicalese
authors.forename: Ali
authors.initials: A
authors.lastname: Shirafkan
authors.forename: Kristofer
authors.initials: K
authors.lastname: Jennings
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Rastellini
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D014195:Travel; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists