Effect of distance from transplant center on outcomes

March 25, 2014

Among veterans meeting eligibility for liver transplantation, greater distance from a Veterans Affairs transplant center or any transplant center was associated with lower likelihood of being put on a waitlist or receiving a transplant, and a greater likelihood of death, according to a study in the March 26 issue of JAMA.

Centralization of specialized health care services is used to control costs, concentrate expertise, and minimize regional differences in quality of care. Although efficient, centralization may offset gains in care delivery by increasing the distance between patients and hospitals. The effect of increased travel on access and outcomes for services such as organ transplantation is not fully understood, according to background information in the article.

David S. Goldberg, M.D., M.S.C.E., of the University of Pennsylvania, Philadelphia, and colleagues linked data from the Veterans Health Administration's electronic medical record to Organ Procurement and Transplantation Network data to evaluate the association between distance from a Veterans Affairs (VA) transplant center (VATC) and waitlisting for liver transplantation, actually having a transplant, and risk of death.

From 2003-2010, 50,637 veterans were classified as potentially eligible for transplant; 6 percent were waitlisted for transplant, and 49 percent of these veterans were waitlisted at 1 of the 5 VATCs. In various models, increasing distance to closest VATC or any transplant center was associated with lower odds of being waitlisted; with lower transplantation rates; and an increased risk of death.

The authors write that these findings may be explained by (1) long travel times from homes remote from a transplant center reducing the likelihood of getting evaluated for transplantation; or (2) reduced ability to proceed with transplantation because of the need for a patient or his or her family members to relocate.

"This issue of distance and access to care is critical given the focus on accountable care organizations that create large networks of physicians and hospitals. As complex, expensive medical technology evolves, certain services may only be offered at a limited number of sites. Although our findings are consistent with prior studies evaluating the association of distance to care, our study is the first, to our knowledge, to demonstrate the adverse consequences of centralization of specialized care at a limited number of sites," the researchers write.

"The relationship between these findings and centralizing specialized care deserves further investigation."
-end-
(doi:10.1001/jama.2014.2520; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: This work was supported in part by a Health Resources and Services Administration contract. The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

The JAMA Network Journals

Related Liver Transplantation Articles from Brightsurf:

Study reveals improving survival rates after liver transplantation in the UK
In the past two decades, death rates after liver transplantation have dropped by more than half in the UK, according to a recent analysis of almost 10,000 liver transplant recipients published in BJS (British Journal of Surgery).

Advancing transplantation: Hepatitis C-infected organs safe for transplantation when followed by antiviral treatment
Twenty patients at Penn Medicine have been cured of the hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease, according to a study published today in Annals of Internal Medicine.

US study reports dramatic reduction in likelihood of liver transplantation in patients with hepatoce
ILC 2018: Although hepatocellular carcinoma is now the leading indication for liver transplantation in the USA, the probability of patients receiving a transplant has declined significantly in recent years.

HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly in the era of direct-acting antiviral drugs
HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly in the era of direct-acting antiviral drugs.

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA
Two independent US studies confirm that, from 2016 onwards, alcoholic liver disease has led to more liver transplants than hepatitis C infection in patients without hepatocellular carcinoma (HCC).

The Journal of Heart and Lung Transplantation: 50 years of heart transplantation progress
This month marks the 50th anniversary of the world's first human heart transplant performed at Groote Schuur Hospital in Cape Town by South African surgeon, Christiaan Barnard.

Researchers develop new technique to model transplantation of the human liver
A novel technology developed by researchers at the Massachusetts General Hospital enables the model-ing of human liver transplantation in an experimental setting.

New method creates liver bioscaffolds with intact ECM for reseeding and transplantation
Researchers have reported a method for successfully removing the cellular material from whole human livers while retaining the organ's three-dimensional structure and extracellular matrix (ECM) components.

Routine hospital tool found to predict poor outcomes after liver transplantation
A routinely used hospital tool can predict which liver transplant recipients are more likely to do poorly after surgery, according to a study led by Cedars-Sinai.

Critically ill children can still undergo liver transplantation and survive
Advancements in critical care make it possible for even the sickest children to successfully undergo liver transplantation.

Read More: Liver Transplantation News and Liver Transplantation Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.