Liver allocation policies are evaluated by how they impact waitlisted patients, without considering broader outcomes for all patients with end-stage liver disease (ESLD) not on the waitlist. We conducted a retrospective cohort study using two nationally-representative databases: HealthCore (2006-2014) and 5-state Medicaid (CA, FL, NY, OH, and PA; 2002-2009). UNOS linkages enabled ascertainment of waitlist and transplant-related outcomes. We included patients aged 18-75 with ESLD (decompensated cirrhosis or hepatocellular carcinoma) using validated ICD-9-based algorithms. Among 16,824 ESLD HealthCore patients, 3-year incidences of waitlisting and transplantation were 15.8% (95% CI: 15.0-16.6%) and 8.1% (7.5-8.8%), respectively. Among 67,706 ESLD Medicaid patients, 3-year incidences of waitlisting and transplantation were 10.0% (9.7-10.4%) and 6.7% (6.5-7.0%), respectively. In HealthCore, the absolute ranges in states' waitlist mortality and transplant rates were larger than corresponding ranges among all ESLD patients (waitlist mortality: 13.6-38.5%, ESLD 3-year mortality: 48.9-62.0%; waitlist transplant rates: 36.3-72.7%, ESLD transplant rates: 4.8-13.4%). States' waitlist mortality and ESLD population mortality were not positively correlated: ρ=-0.06, p-value=0.83 (HealthCore); ρ=-0.87, p-value=0.05 (Medicaid). Waitlist and ESLD transplant rates were weakly positively correlated in Medicaid (ρ=0.36, p-value=0.55), but were positively correlated in HealthCore (ρ=0.73, p-value=0.001). Compared to population-based metrics, waitlist-based metrics overestimate geographic disparities in access to liver transplantation. This article is protected by copyright. All rights reserved.
Pharmacology, Toxicology and Pharmaceutical Science
1
3%
Biochemistry, Genetics and Molecular Biology
1
3%
Other
6
17%
Unknown
10
28%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 22 December 2017.
All research outputs
#8,534,976
of 25,374,647 outputs
Outputs from American Journal of Transplantation
#2,343
of 5,058 outputs
Outputs of similar age
#124,949
of 342,339 outputs
Outputs of similar age from American Journal of Transplantation
#35
of 101 outputs
Altmetric has tracked 25,374,647 research outputs across all sources so far. This one is in the 43rd percentile – i.e., 43% of other outputs scored the same or lower than it.
So far Altmetric has tracked 5,058 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 12.2. This one is in the 41st percentile – i.e., 41% of its peers scored the same or lower than it.
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We're also able to compare this research output to 101 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 62% of its contemporaries.
