Background:

Geographic disparities in access to liver transplantation (LT) has led to candidates seeking LT outside their home UNOS region (“Travelers”). Little is known about their socioeconomic profiles, migration patterns, and donor organ quality.

Methods:

We analyzed all 2010-2014 US non-status 1 adult LT candidates. Travelers were defined as those listed ≥2 regions away from their home region (identified by home state). “Non-Travelers” were listed in their home region. We explored migration patterns, used linear regression to associate travel with donor quality, and Cox regression to evaluate transplant outcomes.

Results:

Of 83,352 candidates, 2,036(2.4%) Travelers listed ≥2 regions from their home. Compared to non-Travelers, Travelers were more likely to be older (56 vs 58y), non-Hispanic White (77 vs 69%), male (71 vs 64%), privately (62 vs 57%) or VA insured (15 vs 1%). They had higher median listing allocation MELD (aMELD;17 vs 15), received more HCC exceptions (22 vs 20%), more likely to receive LT (55 vs 41%), less likely to have died (16 vs 22%) [p<0.01 for each].

Of the 2,036 Travelers, 1,040 (51%) traveled to a region with a median aMELD ≥5 less than their home region: 57% from high aMELD regions 1, 5, or 9; 70% to lower aMELD regions 2, 3, 10. 90/126(71%) centers listed Travelers, but 62% listings and 66% LTs were at 6/126(5%) centers. Travelers received a greater % of DCDD (9 vs 5%) or nationally-shared livers (8 vs 3%), and had shorter cold ischemic times (5.9 vs 6.0h)[p<0.01 for each]. Travelers vs non-Travelers received organs with a median DRI(IQR) 1.48(1.19-1.82) vs 1.44(1.19-1.75)[p<0.01].

Nationwide, Traveler status was associated with DRI 0.02[p=0.05] points higher than non-Travelers. Significant differences existed by region: Travelers from region 5 received livers at a median aMELD24 that were 0.09[p<0.01] DRI points higher than non-Travelers from region 5 at aMELD34. Travelers from region 9 received livers at a median aMELD25 that were 0.24[p<0.01] DRI points lower than non-Travelers from region 9 at aMELD31. Travelers had 20% decreased mortality post-transplant (HR 0.80, 95%CI 0.67-0.95, p=0.01) compared to non-travelers in multivariable analysis.

Conclusions:

The benefits of traveling were largely utilized by candidates who were older, White, male, and privately insured. Traveling for LT is associated with higher rates of LT at lower aMELDs at a small cost in donor quality, except for those originating from region 9.

CITATION INFORMATION: Ge J., Lai J. Waitlist Candidates Who Travel for Liver Transplantation and the Donor Organs They Receive Am J Transplant. 2017;17 (suppl 3).

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