Orthotopic Liver Transplantation in a Multiethnic Population: Role of Spatial Accessibility

Introduction. Access to orthotopic liver transplantation (OLT) varies among different ethnic groups. The aim of this study was to determine if distance from transplantation center (DT) impedes referral pattern and accessibility to OLT among ethnic groups. Method. This is a retrospective cohort study of all patients evaluated for OLT at our center (2002-2007). The Zip Code Basic software was used to compute distance between the candidate's residence and transplantation center. Results. Five hundred one patients were evaluated during the study period and there were 439 (87.6%) whites 43 (8.6%) African Americans (AA), and others (3.8%). The median DT was 36.8 miles (range, 0.5-231), and there was no significant correlation with the Model for End-Stage Liver Disease (MELD) at presentation (P = .87). Although AA had a higher likelihood of residing closer to a transplantation center they were more likely to have a higher MELD at presentation (20 vs 15.4; P < .001) and less likely to be referred early to initiate OLT evaluation (11.6% vs 26.4%; P = .04). Additionally, type of insurance correlated with higher MELD at presentation. Conclusion. DT was not a contributory factor to the observed access disparity in our patient population, rather the insurance type and disease severity as determined using MELD differed significantly among ethnic groups.