Patterns and outcomes associated with patient migration for liver transplantation in the United States

Abstract

Background: Traveling to seek specialized care such as liver transplantation (LT) is a reality in the UnitedStates. 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. Migratedpatients 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 patientswere 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 andrecipient 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 byregional 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 patientpreference.