Distance From VA Liver Transplant Center May Affect Vets' Survival
TUESDAY, March 25, 2014 -- U.S. veterans who need a liver transplant are less likely to get a new organ -- and are more likely to die -- the farther they live from a VA liver transplant center, a new study shows.
"Our study is the first to show that while the VA model of centralized health care might serve to control costs, concentrate specialized expertise and minimize regional differences in the quality of care provided, it actually has negative consequences for many veterans," study author Dr. David Goldberg, an instructor of medicine at the University of Pennsylvania, said in a university news release.
The VA's five liver transplant centers are located in Houston; Nashville; Pittsburgh; Portland, Ore.; and Richmond, Va.
Researchers looked at more than 50,000 veterans who were eligible for liver transplants and received care between 2003 and 2010. For each doubling in distance from their local VA hospital to a VA transplant center -- from 50 to 100 miles, for example -- a veteran had a 9 percent lower chance of being put on the waiting list at a transplant center.
Among veterans with severe liver disease, 7 percent of those within 100 miles and 3 percent of those farther than 100 miles were put on a waitlist. Among those who made it to a waitlist, liver transplants were performed in 64 percent of those within 100 miles and in less than 55 percent of those farther than 100 miles.
"Increased travel time to a transplant center likely prevents patients from being evaluated for transplantation, and thus ultimately making it onto the waitlist," Goldberg said.
And even for patients who do make waitlists, "increased distance is associated with decreased transplant rates, most likely because those patients at greater distances are unable to travel to the designated center quickly enough to receive a transplant after an organ becomes available," Goldberg said.
"Our findings show that this distance places patients who live far away at a disadvantage that may put their lives at risk," he said.
The farther a veteran with liver disease lived from a transplant center, the greater his or her risk of death, found the study, which was published in the March 26 issue of the Journal of the American Medical Association.
Survival rates five years after being diagnosed with liver failure were 58 percent for those living within 100 miles of a transplant center and less than 45 percent for those who lived more than 300 miles away, according to the study.
Although the VA has approved the opening of two new liver transplant centers, distance will still be a problem for many veterans who need a liver transplant, the researchers said.
They suggested other measures, including the use of "telehealth" (making the most of long-distance technologies to improve health care), having local doctors perform waitlist evaluations, streamlining referral to VA transplant centers and reducing financial barriers that prevent veterans from having transplants at hospitals closer to their homes.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about liver transplantation.
Posted: March 2014
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