BACKGROUND: We have previously shown that patients listed for orthotopic liver transplantation (OLT) in United Network for Organ Sharing (UNOS) Region 4 (Texas and Oklahoma) have higher waitlist mortality rates when residing >30 miles from specialized liver transplant centers (LTC). Considering that, findings might only be exclusive for this region with its peculiarities in terms of having the highest land surface extensions, lowest population densities and largest rural populations. We investigated the entire OLT patient population in the United States (US) to assess if our previous regional findings are nationally validated and if a rural, micropolitan or metropolitan residence location affects outcome of waitlisted OLT patients in the nation. METHODS: Patients waiting for OLT in the US from 2002 to 2012 were stratified by distance from the patients’ residence to LTC and by Rural Urban Commuting Area codes (RUCA) classification. Statistical analyses were performed to evaluate risk of mortality on the waitlist and the likelihood to receive an OLT using a Cox proportional hazards model and a generalized additive model (GAM) with a logistic link. RESULTS: Survival time and probability of death while on the waitlist for OLT using distance to LTC showed significant increased risk with the distance (p =0.001 and p <0.0001, respectively). At the same time, using RUCA classification as the variable did not show significance (p =0.14 and p =0.73, respectively). CONCLUSIONS: Distance from a LTC is a risk factor of mortality on the waitlist for OLT, while RUCA classification is not a significant factor.
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