Longer Travel and Traffic are Associated with Adult Liver Transplant Waitlist Mortality in the United States.

Abstract

Transportation to transplant centers is one barrier to liver transplantation (LT). We analyzed the impact of travel metrics on LT waitlist outcomes in the United States. 83,640 adult LT candidates in the Scientific Registry of Transplant Recipients database (2013-2021) were included. Google Distance Matrix API estimated driving time from patients' residing ZIP code to listing center. Effect of travel time [short (<1 hour), medium (1 - < 3 hours), or long (3 - < 6 hours)], traffic congestion in metropolitan areas, and center mismatch (defined as listing at a center >1 hour from nearest center) on waitlist mortality were examined using multivariable competing risk regression with adjustment for confounders. Compared to short travel, medium (HR 1.09 [95% CI: 1.05-1.13]) and long travel times (HR 1.14 [95% CI: 1.08-1.20]) were associated with higher waitlist mortality. Both high (HR 1.09 [95% CI: 1.01-1.12]) and moderate traffic (HR 1.09 [95% CI 1.02-1.15]) was also associated with higher waitlist mortality compared to low traffic. Lastly, there was no relationship between center mismatch (9.1% of listed) and waitlist deaths. Longer travel and traffic congestion are associated with greater waitlist mortality for adult LT candidates. Strategies to address these underrecognized spatial barriers to LT are needed.