Background: Ongoing organ shortage and regional differences in organ availability have encouraged patients in need of liver transplantation (LT) to travel in order to increase the probability of LT. The aim of this study was to identify patterns and predictors of patient migration for LT in the US. Methods: Data for all adult primary deceased donor LT recipients between January 2004 and June 2017 were obtained from the Organ Procurement and Transplantation Network database. We extracted ZIP codes for the patient's residency at registration and for the hospital in which LT took place. These ZIP code data were used to calculate the distance of travel. Patients were considered to have migrated for LT if they traveled greater than 500 miles to undergo LT outside their home region. Multivariable logistic regression analysis was performed to identify predictive factors for patient migration. Results: There were 73,006 eligible LT with valid zip code data during the study period. 3,918 (5.4%) recipients traveled ≥ 500 miles from the time of listing to LT, the majority being to a different state (97.4%) and region (83.9%). Patients who migrated to a distant region for LT were older, more likely to be male, white, and educated, compared to those who did not migrate (p<0.01 for all).They had lower median allocation MELD at LT and were more likely to live in a zip code with higher income quartile, have private insurance, and be multiply listed.

In multivariable analysis, negative predictors of migration included black race (OR 0.57, 95% CI 0.49-0.67), residence in zip code with the lowest income quartile (OR 0.57, 95% CI 0.50-0.64), and those insured by Medicaid (OR 0.15, 95% CI 0.12-0.18). Conclusion: The geographic disparity in access to LT disadvantages minority patients and those with lower income and public insurance. Lack of means to relocate reduces access to LT.

CITATION INFORMATION: Kwong A., Mannalithara A., Kim W. Race, Income, and Insurance Status Predict Migration for Liver Transplantation in the United States Am J Transplant. 2017;17 (suppl 3).

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