%0 Journal Article
%T Patients From Appalachia Have Reduced Access to Liver Transplantation After Wait
%A Dmitry Tumin
%A Don Hayes
%A Eliza W. Beal
%A Joseph D. Tobias
%A Kenneth Washburn
%A Khalid Mumtaz
%A Lanla Conteh
%A Lindsay Sobotka
%A Sylvester M. Black
%A Timothy M. Pawlik
%J Progress in Transplantation
%@ 2164-6708
%D 2018
%R 10.1177/1526924818800037
%X The Appalachian region is medically underserved and characterized by high morbidity and mortality. We investigated disparities among patients listed for liver transplantation (LT) in wait-list outcomes, according to residence in the Appalachian region. Data on adult patients listed for LT were obtained from the United Network for Organ Sharing for July 2013 to December 2015. Wait-list outcomes were compared using cause-specific hazard models by region of residence (Appalachian vs non-Appalachian) among patients listed at centers serving Appalachia. Posttransplant patient and graft survival were also compared. The study included 1835 LT candidates from Appalachia and 5200 from non-Appalachian regions, of whom 1016 patients experienced wait-list mortality or were delisted; 3505 received liver transplants. In multivariable analyses, patients from Appalachia were less likely to receive LT (hazard ratio [HR] = 0.86; 95% confidence interval [CI]: 0.79-0.93; P < .001), but Appalachian residence was not associated with wait-list mortality or delisting (HR = 1.03; 95% CI: 0.89-1.18; P = .696). Among liver transplant recipients, patient and graft survival did not differ by Appalachian versus non-Appalachian residence. Appalachian residence was associated with lower access to transplantation after listing for LT. This geographic disparity should be addressed in the current debate over reforming donor liver allocation and patient priority for LT
%K liver transplant
%K disparities
%K Appalachia
%K rural health-care access
%K donor allocation
%K health-care quality
%K access
%K and evaluation
%K health-care economics and organizations
%K liver transplant recipient < body regions
%K surgical procedures
%K operative
%K population characteristics
%U https://journals.sagepub.com/doi/full/10.1177/1526924818800037