Access to Liver Transplantation in the MELD Era: Role of Ethnicity and Insurance

  • Nyingi Kemmer
  • Victoria Zacharias
  • Tiffany E. Kaiser
  • Guy W. Neff
Original Article

DOI: 10.1007/s10620-008-0567-5

Cite this article as:
Kemmer, N., Zacharias, V., Kaiser, T.E. et al. Dig Dis Sci (2009) 54: 1794. doi:10.1007/s10620-008-0567-5

Abstract

Factors contributing to inequitable access to liver transplantation include socioeconomic status, geographic location, and delayed referral. The aim of this study is to identify the factors associated with a high MELD at the time of listing. Using the UNOS database, we identified all adults listed from 2002 to 2006. Data collected included demographics, insurance payor (private and government, i.e., Medicaid and non-Medicaid), diagnosis, and MELD score categorized as low (<20) and high (≥20). The results obtained show that a high MELD was associated with age, ethnicity, and insurance (P < 0.001). By multivariate analysis, insurance (OR = 1.21, 95% CI = 1.13–1.30, P < 0.001) and ethnicity (OR = 1.55, 95% CI = 1.28–1.88, P < 0.001) were independently associated with high MELD. In conclusion, ethnic minorities and liver transplant candidates with Medicaid are more likely to have a high MELD score at initial listing. The above results suggest that the type of insurance and ethnicity are independently associated with a high MELD (i.e., sicker patients).

Keywords

Liver transplantationEthnicityInsurance

Abbreviations

MELD

Model for End Stage Liver Disease

UNOS

United Network for Organ Sharing

LT

Liver transplantation

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nyingi Kemmer
    • 1
    • 2
  • Victoria Zacharias
    • 1
  • Tiffany E. Kaiser
    • 1
  • Guy W. Neff
    • 1
  1. 1.University of CincinnatiCincinnatiUSA
  2. 2.Cincinnati VA Medical CenterCincinnatiUSA