DSA-level geographic disparity in access to liver transplantation for waitlisted patients has been described, but the impact of this disparity on waitlist mortality is poorly understood.

Methods: Using SRTR data on 30,595 non-HCC incident adult liver waitlist registrants 2014-2016, we calculated liver supply (#livers recovered for transplant per incident waitlist registrant) for each DSA. We then calculated cumulative incidence of waitlist mortality accounting for competing risk of transplantation, stratified by DSA liver supply quartile. We modeled waitlist mortality using competing risks regression, adjusting for initial MELD, age, and race/ethnicity(black/Hispanic/all other).

Results: Liver availability ranged from 23.2-67.4 livers per 100 registrants. Among patients with initial MELD 15-34, patients in DSAs with lower liver supply had higher waitlist mortality (Figure). After casemix adjustment, patients in DSAs with the lowest liver supply (42.4% of all patients) had 53% higher risk of waitlist mortality among MELD 15-21, 1.2-fold higher risk among MELD 22-27, and 55% higher risk among MELD 28-34, compared to patients in DSAs with the highest liver supply (9.3% of all patients) (Table).

In a casemix-adjusted Cox model censoring for transplantation, mortality risk was the same in the lowest quartile and the highest (HR=0.98, p=0.8), suggesting that differences in waitlist mortality were attributable to geographic disparities in allocation rather than inherently different risk of death.

Conclusions: Deceased donor liver availability varies by nearly threefold across DSAs. Except in the very lowest and very highest MELD ranges, liver waitlist patients living in DSAs with lower transplant rates face substantially increased risk of dying before receiving a transplant.

CITATION INFORMATION: Massie A., DiBrito S., Motter J., Henderson M., Zhou S., Jackson K., Segev D., Gentry S. Differences in Liver Waitlist Mortality Due to Geographic Disparity in Organ Availability Am J Transplant. 2017;17 (suppl 3).

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