Aim: Given the current geographic disparities in average MELD scores at liver transplantation (OLT), there is increasing interest in patients who travel for OLT and whether this may related to access to OLT at a lower MELD score. The purpose of this study was to determine whether the patients who travel for OLT appear to be doing so for increased organ access.

Methods: The OPTN database was queried for all patients who underwent a liver transplant from 2010-2013. 182 patients were excluded because state of residence was unknown. Demographic, transplant, and survival data were analyzed for the remaining 25,159 patients. Patients who traveled away from their home region for OLT (TRV) were compared to patients who underwent OLT within their home region (NTRV).

Results: From 2010-2013, 2998 patients (11.8%) traveled outside of their home region for OLT. 58.8% of TRV OLT were done in 4 regions (2, 3, 8, and 11). Median MELD scores for these regions were 27, 24, 26, and 22, respectively. By comparison, these four regions performed only 45.5% of the total OLT in the US. The bottom four regions for traveler destinations performed 14.7% of the TRV OLT (regions 1, 4, 5, and 6). The median MELD scores for these regions were 29, 28, 33, and 26, respectively. The largest net exporter of patients for OLT was Region 5 (Median MELD 33). The largest net importer of patients for OLT was Region 8 (Median MELD 25). 57.7% of all TRV went from a region with a higher median MELD to a region with a lower median MELD. 42.3% went from a region with a lower median MELD to a region with a higher median MELD. 24.8% of TRV went more than 1 geographic region away from home for OLT. Regions 8 and 11 had the highest proportion of TRV in their transplant populations, with 1 in 5 OLTs done in those areas performed on TRV. Overall survival was similar at 6, 12, and 18 months between TRV and NTRV.

Conclusions: A significant proportion of patients travel outside of their home regions for OLT. Given that 42.3% of patients traveled from areas of lower MELDs to areas of higher MELDs, there are reasons other than MELD score that accounts for this travel in many patients. However, there does seem to be a loose association between median MELD scores and the number of patients that travel to certain regions. Further study may elucidate the importance of geographic disparity for patients able to travel for OLT.

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