Liver-related mortality increased nearly 20% after COVID-19 pandemic, varied by state
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Key takeaways:
- Liver-related mortality increased from 77,282 in 2018 to 93,418 in 2021.
- States with the highest liver-related mortality had lower transplant rates.
- Ten states had no transplant centers.
Rates of liver-related mortality increased by 19.1% from 2018 to 2021 and varied “several-fold” between states, underscoring the need for improved access to liver transplantation regardless of location, according to researchers.
“The fair distribution of solid organs continues to be a significant challenge for policymakers seeking to prioritize transplants for the sickest patients first while also fulfilling the goals of equitable access,” Nicolas S. Rinella, MS, of the division of gastroenterology and hepatology at the University of Chicago, colleagues wrote in JAMA Network Open. “Although refinements of organ allocation policies have succeeded in reducing geographic variance in access to liver transplant, organ allocation policies do not address access to transplant centers.
“Thus, while waiting list mortality rates have generally decreased over time, the broader association with liver-related morality (LRM) is unclear.”
To investigate the frequencies and geographic variance of LT and LRM in 2018, before the COVID-19 pandemic, and 2021, Rinella and colleagues analyzed recipient and donor state residence data from United Network for Organ Sharing, Scientific Registry of Transplant Recipients and CDC WONDER databases.
Results demonstrated a 19.1% overall increase in LRM from 77,282 (23.6 per 100,000 individuals) in 2018 to 93,418 (28.1 per 100,000 individuals) in 2021. The variation in mortality was more than fourfold between states in 2021, from 18.4 per 100,000 individuals per year in Utah to 65.9 per 100,000 individuals per year in New Mexico.
States in the highest LRM quintile had a lower rate of in-state donor transplants compared with states in the lowest quintile (13% vs. 35.2%; 95% CI, 14.1-30.3). Further, states with the highest vs. lowest proportion of in-state donor LTs (57% vs. 3%) had a significantly lower mean LRM (25.7 vs. 32.6 per 100,000; 95% CI, 0.5-13.4) compared with those with the lowest proportion of in-state donor LTs.
In addition, there was a significantly lower median number of deaths per LT from in-state donors in the lowest LRM quintile (26.8) vs. the highest quintile (109.9; 95% CI, 26.1-133.2) — a trend that persisted when analyzing deaths from both in-state and out-of-state donors (mean number of deaths, lowest LRM quintile = 7.2 vs. highest LRM quintile = 21.5; 95% CI, 12.1-16.6).
The researchers also reported that 10 states had no LT center, of which 60% had the highest rates of LRM.
“LRM rates have increased dramatically since the COVID-19 pandemic and vary several-fold between states,” Rinella and colleagues wrote. “Liver transplant rates are paradoxically lowest among residents living in states with the highest LRM.”
They continued: “These findings highlight apparent geographic disparities in access to liver transplants that allocation policy cannot address, raising important questions about the need for new strategies to ensure fair and balanced access to liver transplants for all patients, regardless of their location.”
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