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. 2023 May 12;408(1):191.
doi: 10.1007/s00423-023-02874-9.

Regional transplant rates depend more on physician-dependent variables than on proximity to transplant center

Elnaz Payani #  1 , Nikolaus Börner #  1 , Dionysios Kolliogiannis #  1 , Stefan Brunner  2 , Ingo Klein  3 , Ursula Ehmer  4 , Gerald Denk  5 , Christian M Lange  5 , Klaudja Ograja  6 , Peter Dietrich  7 , Jens Werner  1 , Markus Guba  8
Affiliations

Regional transplant rates depend more on physician-dependent variables than on proximity to transplant center

Elnaz Payani et al. Langenbecks Arch Surg. .

Abstract

Purpose: The objective of this work was to uncover inequalities in access to liver transplantation in Bavaria, Germany.

Methods: For this purpose, the annual transplantation rate per 1 million inhabitants for the respective districts was determined from the aggregated postal codes of the place of residence of transplanted patients. The variables examined were proximity and travel time to the nearest transplant center, as well as the care category of the regional hospital. In addition, we assessed whether the head of gastroenterology at the regional hospital through which liver transplant candidates are referred was trained at a liver transplant center.

Results: We could not demonstrate a direct relationship between proximity or travel time to the nearest transplant center and access to liver transplantation. Multivariate regression analysis shows that liver transplant training (p < 0.0001) of the chief physician (gastroenterologist) of the regional hospital was the most decisive independent factor for access to liver transplantation within a district.

Conclusion: We show that the transplant training experience of the head of gastroenterology at a regional hospital is an independent factor for the regional transplantation rate. Therefore, it appears important to maintain some liver transplant expertise outside the transplant centers in order to properly identify and assign potential transplant candidates for transplantation.

Keywords: Disparities in liver transplantation; Liver transplantation; Proximity to liver transplant center; Socioeconomic factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Choropleth map liver transplants/1 million inhabitants/year within a district. Per center: a Munich (established care network with university hospitals Erlangen and Rechts der Isar of the TU Munich), b Regensburg, c Wurzburg, d all centers
Fig. 2
Fig. 2
ROC curves for categorical variables based on the annual transplant rate per 1 million inhabitants per district
Fig. 3
Fig. 3
Bubble plot visualizing the multiple linear regression analysis shows the strong correlation between liver transplant training of the referring physician and the annual liver transplant rate. Blue bubbles represent “no LTX training” red bubbles “LTX trained”; small bubbles “rural” and large bubbles “urban” residence
See this image and copyright information in PMC

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