Waitlist versus Population-Based Metrics of Access to Liver Transplantation: Comparing UNOS Waitlist Data and Nationally-Representative Data of Patients with End-Stage Liver Disease.
1Department of Medicine, University of Pennsylvania, Philadelphia, PA
2Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
Meeting: 2016 American Transplant Congress
Abstract number: B247
Keywords: Allocation
Session Information
Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Strategies for allocating transplantable livers are evaluated based on how they impact waitlisted patients. This approach may not optimize outcomes for all patients with end-stage liver disease (ESLD) if few are ever waitlisted.
Methods: Retrospective cohort study using two nationally representative databases: HealthCore Integrated Research Database (HIRD) from 2006-2014; and 5-state Medicaid (CA, FL, NY, OH, and PA) data from 1999-2009. Linkages with UNOS enabled ascertainment of waitlist and transplant-related outcomes. We included adults <75 years of age with ESLD (decompensated cirrhosis or HCC) using validated ICD-9 algorithms. Primary exposure was state of residence.
Results: Among 16,824 patients with ESLD in HIRD, the 3-year incidence of waitlisting and LT was 15.8% (95% CI: 15.0-16.6%) and 8.1% (7.5-8.8%), respectively. Among 91,899 patients with ESLD in Medicaid, the 3-year incidence of waitlisting and LT was 8.9% (8.7-9.2%) and 3.1% (2.9-3.3%), respectively. The 3-year survival from ESLD diagnosis was significantly longer among waitlisted patients in both cohorts (HIRD: 76.4% versus 55.2%; Medicaid: 70.4% versus 39.5%; both p<0.001). In HIRD, the absolute variances in waitlist mortality and LT rates among 16 states were larger than corresponding variances among all ESLD patients (among-state waitlist mortality: 13.6-38.5% versus ESLD 3-year mortality: 48.9-62.0%; among-state waitlist LT rates: 36.3-72.7% versus ESLD LT rates: 4.8-13.4%). States' waitlist mortality and ESLD population mortality rates were not positively correlated in either cohort: [rho]=-0.06, p-value=0.83 (HIRD); [rho]=-0.51, p-value=0.37 (Medicaid). Waitlist and ESLD LT rates were weakly correlated in Medicaid ([rho]=-0.48, p-value=0.42) and only moderately correlated in HIRD ([rho]=0.73, p-value=0.001).
Conclusions: In the 3-year period after the diagnosis of ESLD, less than 1 in 6 patients who might benefit from LT are ever waitlisted, and less than 1 in 12 is transplanted. Using waitlist-based metrics to guide organ allocation policy may overestimate geographic disparities by neglecting the majority of potential beneficiaries of transplantation.
CITATION INFORMATION: Goldberg D, French B, Lewis J, Halpern S. Waitlist versus Population-Based Metrics of Access to Liver Transplantation: Comparing UNOS Waitlist Data and Nationally-Representative Data of Patients with End-Stage Liver Disease. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Goldberg D, French B, Lewis J, Halpern S. Waitlist versus Population-Based Metrics of Access to Liver Transplantation: Comparing UNOS Waitlist Data and Nationally-Representative Data of Patients with End-Stage Liver Disease. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/waitlist-versus-population-based-metrics-of-access-to-liver-transplantation-comparing-unos-waitlist-data-and-nationally-representative-data-of-patients-with-end-stage-liver-disease/. Accessed June 23, 2025.« Back to 2016 American Transplant Congress