Chin Simone, Kench Charlotte, Cao Rena, Lee Christina, Waller Karen, Virtue Susan, West Claire, Valliani Talal, Bowen David G, Jacob Rachael, Gill Madeleine, Pulitano Carlo, Crawford Michael, Strasser Simone I, McCaughan Geoffrey W, Liu Ken
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2025 Apr;55(4):564-572. doi: 10.1111/imj.16631. Epub 2025 Jan 13.
Access to liver transplantation (LT) is affected by geographic disparities. Higher waitlist mortality is observed in patients residing farther from LT centres, but the impact of distance on post-LT outcomes is unclear.
To evaluate whether the distance LT recipients reside from their LT centre affects graft and patient outcomes.
We retrospectively studied consecutive adult patients who received deceased donor LT at a statewide LT referral centre, Royal Prince Alfred Hospital (RPAH), 2006-2021. The primary outcome was overall patient survival.
A total of 973 patients who underwent LT during the study period were analysed. The median distance from patient residence to RPAH was 44.9 km (interquartile range 21.9-168.0). Of these, 64.2% lived ≤100 km from RPAH. Compared to patients living ≤100 km from RPAH, those living >100 km away were less likely to be male, have chronic hepatitis B as their cause of liver disease or have hepatocellular carcinoma as their primary indication for LT. Living >100 km from RPAH was associated with fewer face-to-face clinic visits in the first year after LT (10 vs 11 visits, P < 0.001) and fewer readmissions to RPAH (32.4% vs 67.6%, P < 0.001). Distance from RPAH, regional code and socioeconomic code did not affect long-term graft or patient survival based on Kaplan-Meier survival analysis (log-rank P > 0.1).
In our single-centre Australian study, patients living farther from their LT centre had different demographics. Distance from the LT centre was not associated with long-term inferior graft or patient survival after LT.
肝移植（LT）的可及性受到地理差异的影响。居住在距离肝移植中心较远的患者等待名单上的死亡率更高，但距离对肝移植后结局的影响尚不清楚。
评估肝移植受者居住距离其肝移植中心是否会影响移植物和患者结局。
我们回顾性研究了2006年至2021年期间在全州肝移植转诊中心皇家阿尔弗雷德王子医院（RPAH）接受尸体供肝肝移植的成年连续患者。主要结局是患者总体生存。
共分析了研究期间接受肝移植的973例患者。患者居住地到RPAH的中位距离为44.9公里（四分位间距21.9 - 168.0）。其中，64.2%居住在距离RPAH≤100公里处。与居住在距离RPAH≤100公里的患者相比，居住在>100公里外的患者男性比例较低、因慢性乙型肝炎导致肝病或因肝细胞癌作为肝移植主要指征的可能性较小。居住在距离RPAH>100公里处与肝移植后第一年较少的面对面门诊就诊次数（10次对11次，P < 0.001）和较少的再次入住RPAH次数（32.4%对67.6%，P < 0.001）相关。根据Kaplan-Meier生存分析，距离RPAH、地区代码和社会经济代码不影响长期移植物或患者生存（对数秩检验P > 0.1）。
在我们的澳大利亚单中心研究中，居住距离肝移植中心较远的患者人口统计学特征不同。肝移植中心的距离与肝移植后长期移植物或患者生存较差无关。
