Patterns and Outcomes Associated with Patient Migration for Liver Transplantation in the United States

Kristopher P Croome; David D Lee; Justin M Burns; Dana K Perry; Andrew P Keaveny; C Burcin Taner

doi:10.1371/journal.pone.0140295

Patterns and Outcomes Associated with Patient Migration for Liver Transplantation in the United States

PLoS One. 2015 Oct 15;10(10):e0140295. doi: 10.1371/journal.pone.0140295. eCollection 2015.

Authors

Kristopher P Croome¹, David D Lee¹, Justin M Burns¹, Dana K Perry¹, Andrew P Keaveny¹, C Burcin Taner¹

Affiliation

¹ Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.

Abstract

Background: Traveling to seek specialized care such as liver transplantation (LT) is a reality in the United States. Patient migration has been attributed to organ availability. The aims of this study were to delineate patterns of patient migration and outcomes after LT.

Study design: All deceased donor LT between 2008-2013 were extracted from UNOS data. Migrated patients were defined as those patients who underwent LT at a center in a different UNOS region from the region in which they resided and traveled a distance > 100 miles.

Results: Migrated patients comprised 8.2% of 28,700 LT performed. Efflux and influx of patients were observed in all 11 UNOS regions. Regions 1, 5, 6, and 9 had a net efflux, while regions 2, 3, 4, 7, 10, and 11 had a net influx of patients. After multivariate adjustment for donor and recipient factors, graft (p = 0.68) and patient survival (p = 0.52) were similar between migrated and non-migrated patients.

Conclusion: A significant number of patients migrated in patterns that could not be explained alone by regional variations in MELD score and wait time. Migration may be a complex interplay of factors including referral patterns, specialized services at centers of excellence and patient preference.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Graft Survival
Humans
Liver Diseases / therapy*
Liver Transplantation* / statistics & numerical data
Male
Middle Aged
Tissue Donors / statistics & numerical data
Tissue and Organ Procurement / organization & administration*
Tissue and Organ Procurement / statistics & numerical data
Travel* / statistics & numerical data
Treatment Outcome
United States

Grants and funding

Funding provided internally by Mayo Clinic Collaborative in Transplant Research and Outcomes. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.