COMPARISON OF LIVER TRANSPLANTATION OUTCOMES BY INSURANCE TYPE IN THE ACUITY CIRCLES ERA

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Previous studies have demonstrated liver transplant candidates covered by Medicare or Medicaid have inferior waitlist outcomes and higher post-transplant mortality. This study aims to elucidate the effects of insurance type on liver transplantation outcomes with the recent introduction of the acuity circles liver allocation policy. Methods: All adult liver transplant candidates in the UNOS STAR file waitlisted from Jan 11 2016 to Sept 30 2021 were included. Living liver grafts, pediatric, and non-kidney simultaneous transplantation were excluded. Fine gray regression models were fitted to identify competing risk of death on waitlist or removal for being too sick, and deceased donor transplantation between Medicare/ Medicaid covered patients compared to private insurance. Cox proportional hazards models were fitted to identify 6-month and 1-year patient and liver graft survival between Medicare/Medicaid covered patients compared to private insurance. Outcomes were stratified by pre-AC (1/11/2016-2/ 3/2020) and post-AC (2/4/2020-9/ 30/2020) eras. Results: 61739 liver transplant candidates were included in this study, 53150 in the pre-AC and 8589 in the post-AC eras respectively. 21019 (34%) patients in the cohort were covered by Medicare/Medicaid insurance. Medicare/Medicaid covered patients had significantly increased risk of waitlist death (HR=1.12, P <0.001, 95% C.I.=1.07-1.17) and lower chance of proceeding to liver transplantation (HR=0.90, P <0.001, 95% C.I.=0.88-0.92) compared to those with private insurance in the pre-AC era but not the post-AC era [waitlist death: (HR=1.07, P=0.33, 95% C.I.=0.94-1.21), liver transplant: (HR=0.95, P=0.13, 95% C.I.=0.91-1.01)]. Medicare/Medicaid covered patients had significantly increased 1 year patient death in the in the pre-AC era (HR=1.10, P=0.05, 95% C.I.=1.001-1.21) but not the post-AC era (HR=1.20, P=0.09, 95% C.I.=0.97-1.48). Medicare/Medicaid covered patients had similar 1 year liver graft outcomes in the pre-AC era (HR=1.08, P=0.10, 95% C.I.=0.99-1.18) but significantly worse 1 year liver graft survival the post-AC era (HR=1.21, P=0.047, 95% C.I.=1.002-1.47). Conclusion: Liver transplantation candidates covered by Medicare or Medicaid had similar waitlist and 1 year patient survival but inferior 1 year liver graft survival compared to those covered by private insurance with the introduction of the acuity circles policy. (Figure Presented).

Volume

76

Issue

S1

First Page

S503

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