Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

MELD:

Model for End Stage Liver Disease

UNOS:

United Network for Organ Sharing

LT:

Liver transplantation

References

  1. Higgins RS, Fishman JA. Disparities in solid organ transplantation for ethnic minorities: facts and solutions. Am J Transplant. 2006;6:2556–2562. doi:10.1111/j.1600-6143.2006.01514.x.

    Article  PubMed  CAS  Google Scholar 

  2. Kemmer N, Safdar K, Kaiser T, Zacharias V, Neff GW. Impact of geographic location on access to liver transplantation among ethnic minorities. Transplantation. 2008;85:166–170.

    Article  PubMed  Google Scholar 

  3. Ifudu O, Dawood M, Iofel Y, Valcourt JS, Friedman EA. Delayed referral of Black, Hispanic, and older patients with chronic renal failure. Am J Kidney Dis. 1999;33:728–733. doi:10.1016/S0272-6386(99)70226-X.

    Article  PubMed  CAS  Google Scholar 

  4. Lhotta K, Zoebl M, Mayer G, Kronenberg F. Late referral defined by renal function: association with morbidity and mortality. J Nephrol. 2003;16:855–861.

    PubMed  Google Scholar 

  5. Cass A, Cunningham J, Arnold PC, Snelling P, Wang Z, Hoy W. Delayed referral to a nephrologist: outcomes among patients who survive at least one year on dialysis. Med J Aust. 2002;177:135–138.

    PubMed  Google Scholar 

  6. Eckhoff DE, McGuire BM, Young CJ, et al. Race: a critical factor in organ donation, patient referral and selection, and orthotopic liver transplantation? Liver Transpl Surg. 1998;4:499–505. doi:10.1002/lt.500040606.

    Article  PubMed  CAS  Google Scholar 

  7. Cass A, Cunningham J, Snelling P, Ayanian JZ. Late referral to a nephrologist reduces access to renal transplantation. Am J Kidney Dis. 2003;42:1043–1049.

    PubMed  Google Scholar 

  8. Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM. The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality. Am J Transplant. 2008;8:419–425.

    PubMed  CAS  Google Scholar 

  9. Roberts JP, Dykstra DM, Goodrich NP, Rush SH, Merion RM, Port FK. Geographic differences in event rates by model for end-stage liver disease score. Am J Transplant. 2006;6:2470–2475. doi:10.1111/j.1600-6143.2006.01508.x.

    Article  PubMed  CAS  Google Scholar 

  10. Ahmad J, Bryce CL, Cacciarelli T, Roberts MS. Differences in access to liver transplantation: disease severity, waiting time, and transplantation center volume. Ann Intern Med. 2007;146:707–713.

    PubMed  Google Scholar 

  11. Heuman DM, Abou-Assi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004;40:802–810.

    PubMed  Google Scholar 

  12. Thamer M, Henderson SC, Ray NF, Rinehart CS, Greer JW, Danovitch GM. Unequal access to cadaveric kidney transplantation in California based on insurance status. Health Serv Res. 1999;34:879–900.

    PubMed  CAS  Google Scholar 

  13. Keith D, Ashby VB, Port FK, Leichtman AB. Insurance type and minority status associated with large disparities in prelisting dialysis among candidates for kidney transplantation. Clin J Am Soc Nephrol. 2008;3:463–470. doi:10.2215/CJN.02220507.

    Article  PubMed  Google Scholar 

  14. Yoo HY, Thuluvath PJ. Outcome of liver transplantation in adult recipients: influence of neighborhood income, education, and insurance. Liver Transpl. 2004;10:235–243. doi:10.1002/lt.20069.

    Article  PubMed  Google Scholar 

  15. Russo MW, Sandler RS, Mandelkehr L, Fair JH, Johnson MW, Brown RS Jr. Payer status, but not race, affects the cost of liver transplantation. Liver Transpl Surg. 1998;4:370–377. doi:10.1002/lt.500040510.

    Article  PubMed  CAS  Google Scholar 

  16. Clancy CM, Franks P. Utilization of specialty and primary care: the impact of HMO insurance and patient-related factors. J Fam Pract. 1997;45:500–508.

    PubMed  CAS  Google Scholar 

  17. Backus L, Osmond D, Grumbach K, Vranizan K, Phuong L, Bindman AB. Specialists’ and primary care physicians’ participation in Medicaid managed care. J Gen Intern Med. 2001;16:815–821. doi:10.1046/j.1525-1497.2001.01239.x.

    Article  PubMed  CAS  Google Scholar 

  18. Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol. 2008;9:222–231. doi:10.1016/S1470-2045(08)70032-9.

    Article  PubMed  Google Scholar 

  19. Obialo CI, Ofili EO, Quarshie A, Martin PC. Ultralate referral and presentation for renal replacement therapy: socioeconomic implications. Am J Kidney Dis. 2005;46:881–886. doi:10.1053/j.ajkd.2005.08.003.

    Article  PubMed  Google Scholar 

  20. Agency for Healthcare Research and Quality. www.ahrq.gov/qual/disparities.htm.

  21. Verma S, Torbenson M, Thuluvath PJ. The impact of ethnicity on the natural history of autoimmune hepatitis. Hepatology. 2007;46:1828–1835. doi:10.1002/hep.21884.

    Article  PubMed  Google Scholar 

  22. Weston SR, Leyden W, Murphy R, et al. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology. 2005;41:372–379. doi:10.1002/hep.20554.

    Article  PubMed  Google Scholar 

  23. Peters MG, Di Bisceglie AM, Kowdley KV, et al. Differences between Caucasian, African American, and Hispanic patients with primary biliary cirrhosis in the United States. Hepatology. 2007;46:769–775. doi:10.1002/hep.21759.

    Article  PubMed  Google Scholar 

  24. Kemmer N, Neff G, Secic M, Zacharias V, Kaiser T, Buell J. Ethnic differences in hepatocellular carcinoma: implications for liver transplantation. Dig Dis Sci. 2008;53:551–555. doi:10.1007/s10620-007-9872-7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Cincinnati, 231 Albert Sabin Way, MSB Room 6363, Cincinnati, OH, 45267-0595, USA

    Nyingi Kemmer, Victoria Zacharias, Tiffany E. Kaiser & Guy W. Neff

  2. Cincinnati VA Medical Center, Cincinnati, USA

    Nyingi Kemmer

Authors
  1. Nyingi Kemmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victoria Zacharias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tiffany E. Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guy W. Neff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nyingi Kemmer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kemmer, N., Zacharias, V., Kaiser, T.E. et al. Access to Liver Transplantation in the MELD Era: Role of Ethnicity and Insurance. Dig Dis Sci 54, 1794–1797 (2009). https://doi.org/10.1007/s10620-008-0567-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0567-5

Keywords

Search

Navigation