Journal article
Following the Organ Supply: Assessing the Benefit of Inter-DSA Travel in Liver Transplantation
Transplantation, Vol.95(2), pp.361-371
01/27/2013
DOI: 10.1097/TP.0b013e3182737cfb
PMID: 23250334
Abstract
Background. Disparity in access to liver transplantation (LT) in the United States persists despite directives from the federal government to reduce geographic variation. We assessed the impact of socioeconomic status (SES) and traveling to alternative donation service areas (DSAs) on patient survival.
Methods. A prospective cohort study integrating transplant registry and U. S. Census data was analyzed using multivariate linear Cox proportional hazards models. A separate matched-pairs analysis was used to assess the benefit of traveling on patient survival and transplantation rate.
Results. High SES is associated with increased access to LT (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [95% CI], 1.01-1.08) and reduced mortality after waitlisting (aHR [95% CI], 0.88 [0.85-0.93]). Increased access is mediated, in part, through inter-DSA travel. Travel was associated with high SES, white race, blood group O, private insurance, and residence in regions 1, 5, and 11. Transplant candidates in the highest SES quartile were approximately 70% more likely to travel (aHR [95% CI], 1.67 [1.43-1.97]) than those in the lowest SES quartile. Compared with matched control patients, travelers were 74% more likely to be transplanted (aHR [95% CI], 1.74 [1.56-1.94]) and 20% less likely to die after listing (aHR [95% CI], 0.79 [0.69-0.92]).
Conclusion. High SES and inter-DSA travel are strongly associated with increased LT access and reduced mortality. Travelers are more likely to be sociodemographically advantaged and privately insured and to live in regions with reduced access to deceased-donor organs.
Details
- Title: Subtitle
- Following the Organ Supply: Assessing the Benefit of Inter-DSA Travel in Liver Transplantation
- Creators
- Nino Dzebisashvili - Saint Louis UniversityAllan B. Massie - Johns Hopkins UniversityKrista L. Lentine - Saint Louis UniversityMark A. Schnitzler - Saint Louis UniversityDorry Segev - Saint Louis UniversityJanet Tuttle-Newhall - Saint Louis UniversitySommer Gentry - United States Naval AcademyRichard Freeman - Dartmouth CollegeDavid A. Axelrod - Dartmouth College
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.95(2), pp.361-371
- DOI
- 10.1097/TP.0b013e3182737cfb
- PMID
- 23250334
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- Hitchcock Foundation RC1 1RC1DK086450-01; K08DK073036 / National Institute of Diabetes Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) RC1DK086450 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 01/27/2013
- Academic Unit
- Surgery
- Record Identifier
- 9984322813602771
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