ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

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.

D. Goldberg,1,2 B. French,2 J. Lewis,1,2 S. Halpern.1,2

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).

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

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 May 31, 2025.

« Back to 2016 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences