Introduction: Distance from a liver transplant (LT) center does not affect outcomes; however, rural areas have lower rates of listing and receiving solid organ transplants. It is unclear which factors influence a physician's attitude regarding candidacy for LT. The aim of this study was to investigate trends in referral for LT evaluation based on physician-dependent variables. Methods: An online survey was distributed to a cohort of a community of women physicians. Questions pertained to physician demographics, including age, specialty, practice location, and any training at a LT center. Distances to the nearest transplant center and population density were calculated based on practice zip code. Variables studied included length of sobriety, patient age and BMI required for transplant evaluation. Responses were analyzed using univariate ordinal logistic regression models and multivariable analyses. Results: Two hundred and ninety-nine physician respondents were analyzed. Physicians without LT center training were 2.05 (CI 1.33-3.17) times more likely to require longer duration of sobriety. As distance increased from a transplant center, the odds of requiring longer sobriety increased by 1.43 (CI 1.11 – 1.83). Population density, age of physician and academic practice setting had no significant impact on duration of sobriety required. Gastroenterologists (GI) and Transplant Hepatologists (TH) showed significant differences in referral candidacy for patients with alcohol related liver diseases (p<.0001). When compared to GI/TH, primary care physicians were more likely to require longer duration of sobriety at 2.11 (0.97 – 4.58). No significant physician dependent variables were found in respect age or BMI. When controlling for all other variables, physicians were 51% (OR=1.51, 95% CI: 1.18 – 1.95) more likely to select a lower BMI cut off for each corresponding one unit increase on the length of sobriety selection. No significant relationship was detected between responses for patient age cut-offs and length of sobriety. Discussion: Our study demonstrates physician dependent variables exist in referral for transplant evaluation. GI and TH were more likely to refer higher risk patients. This suggests a disparity in referral to transplantation depending on their access to sub-specialty GI care or a physician trained at a transplant center. Further attention is needed to better understand the reasons for variation in referral patterns of patients with alcohol related liver disease.

CITATION INFORMATION: Loy V, Rzepczynski A, Bello S, Blackburn C, Lu A. Disparity in Transplant Referral Patterns Based on Physician Dependent Variables. Am J Transplant. 2017;17 (suppl 3).

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