Impact of distance from liver transplant centre on outcomes following liver transplantation: an Australian single-centre study.

Abstract

Background: Access to liver transplantation (LT) is affected by geographic disparities. Higher waitlist mortality is observed in patients residing farther from LT centres, but the impact of distance on post-LT outcomes is unclear.

Aims: To evaluate whether the distance LT recipients reside from their LT centre affects graft and patient outcomes.

Methods: We retrospectively studied consecutive adult patients who received deceased donor LT at a statewide LT referral centre, Royal Prince Alfred Hospital (RPAH), 2006-2021. The primary outcome was overall patient survival.

Results: A total of 973 patients who underwent LT during the study period were analysed. The median distance from patient residence to RPAH was 44.9 km (interquartile range 21.9-168.0). Of these, 64.2% lived ≤100 km from RPAH. Compared to patients living ≤100 km from RPAH, those living >100 km away were less likely to be male, have chronic hepatitis B as their cause of liver disease or have hepatocellular carcinoma as their primary indication for LT. Living >100 km from RPAH was associated with fewer face-to-face clinic visits in the first year after LT (10 vs 11 visits, P < 0.001) and fewer readmissions to RPAH (32.4% vs 67.6%, P < 0.001). Distance from RPAH, regional code and socioeconomic code did not affect long-term graft or patient survival based on Kaplan-Meier survival analysis (log-rank P > 0.1).

Conclusion: In our single-centre Australian study, patients living farther from their LT centre had different demographics. Distance from the LT centre was not associated with long-term inferior graft or patient survival after LT.