DSA-level geographic disparity in access to deceased-donor liver transplantation is well described. However, understanding the relationship between liver availability in a DSA and exportation of recovered livers within that DSA is critical for characterizing the impacts of geographic inequity.

METHODS: Using SRTR data 2013-2017, we identified 20,219 adult deceased-donor livers that were eventually used for transplant. Liver supply-demand ratio (ratio of recovered livers to incident waitlist registrants) for each DSA was classified in quartiles (Q1-Q4: lowest-highest). We calculated the association between liver export (liver transplanted outside of the DSA from which it was recovered) and liver supply-demand ratio quartiles using logistic regression, adjusting for donor age, gender, race, cause of death, and DCD/DBD status.

RESULTS: Overall 33.05% (6,683) of transplanted livers were exported. The proportion exported ranged from 23.8% in DSAs with the lowest liver supply to 51.6% in DSAs with the highest liver supply (Table 1). After adjustment, compared to Q1, odds of liver export was 48% (aOR=_1.351.48_1.61, p<0.001) higher in Q2, 54% (aOR=_1.421.54_1.68, p<0.001) higher in Q3, and 3.6-folds higher in Q4 (aOR=_3.263.57_3.91, p<0.001) (Table 2).

CONCLUSION: DSAs with a large number of liver waitlist registrants and few available deceased-donor livers utilize a higher proportion of locally offered livers.

CITATION INFORMATION: Zhou S., Bowring M., Massie A., Gentry S., Segev D. DSA-Level Liver Availability and Liver Utilization Am J Transplant. 2017;17 (suppl 3).

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