FACTORS INFLUENCING WAITING TIME AND SUCCESSFUL RECEIPT OF CADAVERIC LIVER-TRANSPLANT IN THE UNITED-STATES - 1990 TO 1992

OBJECTIVES. Despite concern about access to liver transplantation, the re has been no nationally based analysis of patients waiting for cadav eric liver transplant. Using data from the United Network for Organ Sh aring Organ Procurement and Transplantation Network database waiting a nd recipient lists, we examined the influence of medical and nonmedica l factors on the length of time patients waited before transplant and whether they survived the wait. METHODS. The authors analyzed 7,422 en tries to the waiting list from October 1, 1990 to December 31, 1992. U sing Cox Proportional Hazard models, time to transplant was modelled b y gender, nationality and ethnicity, age, blood type, medical status ( critically ill versus noncritical), transplant number (first versus re transplant), United Network for Organ Sharing region of the country an d three measures of local demand and supply of organs. The risk of dyi ng before being allocated an organ was compared with receiving an orga n using multiple logistic regression models. RESULTS. In addition to d ifferences by medical status, blood type, geographic region, and organ supply and demand, it was found that women, Hispanic-Americans, Asian -Americans, and children waited longer for transplant, whereas foreign nationals and repeat transplant patients waited fewer days. The risk of dying before transplant was greater for critically ill and repeat t ransplant patients, as well as for women, older patients, Asian-Americ ans, and African-Americans. Children were less likely to die, as were patients from certain blood groups and geographic regions. CONCLUSIONS . Results confirm known patterns of waiting list experience for liver transplant patients, but also identify factors previously unrecognized as influencing waiting time and outcome. Potential explanatory factor s and areas for further inquiry are discussed.