Addressing Geographic Disparities in Liver Transplantation through Redistricting

Sommer E. Gentry; Allan B. Massie; Sidney W. Cheek; Krista L. Lentine; Eric K. H. Chow; Corey E. Wickliffe; Nino Dzebashvili; Paolo R. Salvalaggio; Mark A. Schnitzler; David A. Axelrod; Dorry L. Segev

doi:10.1111/ajt.12301

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Addressing Geographic Disparities in Liver Transplantation through Redistricting

Journal article

Open access

Peer reviewed

Addressing Geographic Disparities in Liver Transplantation through Redistricting

Sommer E. Gentry, Allan B. Massie, Sidney W. Cheek, Krista L. Lentine, Eric K. H. Chow, Corey E. Wickliffe, Nino Dzebashvili, Paolo R. Salvalaggio, Mark A. Schnitzler, David A. Axelrod, …

American journal of transplantation, Vol.13(8), pp.2052-2058

07/09/2013

DOI: 10.1111/ajt.12301

PMCID: PMC4674218

PMID: 23837931

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Abstract

Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90-day transplant rates range from 18%–86% and death rates range from 14%–82% across donor service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28,063 liver transplant candidates, and 242,727 Model of End-Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p=0.021), although it would decrease waitlist deaths (from 1368 to 1329, p=0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p=0.002) while achieving a larger decrease in waitlist deaths (to 1307, p=0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.

Broader sharing

Geographic disparities

Liver allocation

Liver Simulated Allocation Model

Details

Title: Subtitle: Addressing Geographic Disparities in Liver Transplantation through Redistricting
Creators: Sommer E. Gentry - Johns Hopkins Medicine
Allan B. Massie - Johns Hopkins University
Sidney W. Cheek - United States Naval Academy
Krista L. Lentine - Johns Hopkins University School of Medicine
Eric K. H. Chow - Johns Hopkins Medicine
Corey E. Wickliffe - Johns Hopkins Medicine
Nino Dzebashvili - Johns Hopkins University School of Medicine
Paolo R. Salvalaggio - Hospital Israelita Albert Einstein
Mark A. Schnitzler - Saint Louis University
David A. Axelrod - Dartmouth–Hitchcock Medical Center
Dorry L. Segev - Johns Hopkins Medicine
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.13(8), pp.2052-2058
DOI: 10.1111/ajt.12301
PMID: 23837931
PMCID: PMC4674218
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Language: English
Date published: 07/09/2013
Academic Unit: Surgery
Record Identifier: 9984322935502771

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