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Higher chance of transplantation outside of UNOS Region 5

Liver transplant candidates who sought multiple listing had a higher chance of transplantation outside of UNOS Region 5 — consisting of Arizona, California, Nevada, New Mexico and Utah — according to recent findings published in Clinical Gastroenterology and Hepatology.

“Those with multiple listings have significantly better odds of receiving a liver transplant at a lower MELD score,” Aijaz Ahmed, MD, in the division of gastroenterology and hepatology at Stanford University School of Medicine, and colleagues wrote. “Our data suggest socioeconomic background, ethnicity, and level of education influence the practice of multiple listing for liver transplantation, a finding that is comparable to those studied in heart transplant allocation.”

Geographic differences among the 11 United Network for Organ Sharing (UNOS) regions determine waitlist mortality, the researchers wrote. In 2013, 3,075 candidates died awaiting liver transplant in UNOS Region 5. Further, UNOS Region 5 had the highest number of candidates seeking transplant outside the region.

To assess the disparities in this region, Ahmed and colleagues conducted a retrospective analysis using the UNOS database from 2010 to 2015. The researchers compared demographic and clinical characteristics of candidates transplanted at their primary UNOS Region vs. their secondary region. The primary endpoint was the probability of undergoing transplant by staying in the region vs. traveling to another region.

Researchers found the cohort that underwent transplant outside of Region 5 (n = 304) vs. the cohort that underwent transplant in the region (n = 4,679) had a significant increase in the proportion of white patients (75% vs. 53.3%; P < .001), graduate degrees (17.8% vs. 6.8%; P < .001) and higher median household income ($70,783 vs. $62,554; P < .001). For those who sought transplant outside the region through multiple listing, there was a higher probability of receiving the transplant (83% vs. 36%; P < .001) and a lower average MELD score (25.31 vs. 32.25; P < .001). These differences remained significant after excluding hepatocellular carcinoma cases.

In 2013, UNOS required donor policy to be based on illness acuity rather than distance, the researchers wrote. Short-term analyses of the new policy showed an increase in liver transplants and a decrease in waitlist mortality. These results support the need for UNOS Regions redistributing.

“The imbalance in the organ supply to demand ratio in UNOS Regions, including Region 5, incentivizes candidates to seek multiple listing in UNOS Regions with comparatively shorter waitlist-time-to-transplant,” Ahmed and colleagues wrote. “Efforts must be made to eliminate these disparities and establish a fair and balanced allocation system.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.