Association of Distance From a Transplant Center With Access to Waitlist Placement, Receipt of Liver Transplantation, and Survival Among US Veterans

Goldberg, David S.; French, Benjamin; Forde, Kimberly A.; Groeneveld, Peter W.; Bittermann, Therese; Backus, Lisa I.; Halpern, Scott D.; Kaplan, David E.

doi:10.1001/jama.2014.2520

Cited by 131 publications

(153 citation statements)

References 34 publications

(45 reference statements)

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“…This result disagree with Mendes et al, (2013) who conducted a study at Brazil about; educational intervention for liver transplant candidates, they found that most of liver transplant clients were living in urban areas. [28][29][30] The cause of difference between the previous studies and the current study may be related to increased prevalence rate of bilhariziasis in rural areas, which is one of the most leading causes of liver transplantation, and increasing numbers of liver transplant centers all over Egypt.…”

Section: Discussioncontrasting

confidence: 60%

Knowledge and Daily Living Activities of Post Liver Transplant Clients

Abdel-Ghany¹,

Soliman²,

Abdel-Raoof³

2016

IOSR

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Section: Discussioncontrasting

confidence: 60%

Knowledge and Daily Living Activities of Post Liver Transplant Clients

Abdel-Ghany¹,

Soliman²,

Abdel-Raoof³

2016

IOSR

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“…(17) We conducted a retrospective cohort study of veterans with at least one positive hepatitis B surface antigen (HBsAg 1 ) result from April 6, 1999, to December 31, 2013, using the VA Corporate Data Warehouse, a central data repository of VHA clinical and administrative databases used in multiple studies. (18,19) In order to study care patterns in consistent users of VA care, we defined regular users of VA care as patients who had at least two outpatient primary care appointments within the VA for 2 years following the index HBsAg 1 result. (20) As length of follow-up was variable, when evaluating process outcomes, we excluded patients with less than 2 years of follow-up data and excluded patients with index HBsAg 1 from 1999 to 2002 due to missing data for laboratory values and prescriptions.…”

Section: Setting/data Sourcementioning

confidence: 99%

“…We additionally evaluated for potential differences in care received at an academically affiliated versus a community-based VA medical center. (18) Results From 1999 to 2013, a total of 2,533,565 US veterans had HBsAg testing; 26,407 (1.0% of the tested cohort) had at least one HBsAg 1 result. In order to study care patterns in consistent users of VA care, we excluded 4876 patients who did not have at least two outpatient primary care appointments within the VA for 2 years following the HBsAg1 result.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

et al. 2016

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Previous studies have identified gaps in hepatitis B care. The objectives of this study were to evaluate the delivery of care among a national cohort of US veterans with chronic hepatitis B infection and examine risk factors for adverse clinical outcomes. We conducted a retrospective cohort study using the Veterans Health Administration Corporate Data Warehouse from 1999 to 2013 to evaluate (1) care delivery and (2) clinical outcomes such as hepatocellular carcinoma, hepatic decompensation, and mortality among US veterans with hepatitis B. Incidence rates with 95% confidence intervals were calculated and Cox regression models were used to evaluate clinical outcomes. We identified 21,419 veterans with a positive hepatitis B surface antigen, and 97% of patients had alanine aminotransferase and 44% had hepatitis B virus DNA testing; hepatitis B e antigen and hepatitis B e antibody were tested <50% of the time. Patients receiving specialty care had a higher prevalence of recommended laboratory testing. Patients with elevated alanine aminotransferase in specialty care were more likely to receive antiviral therapy (50% versus 24% for specialty care versus no specialty care, P < 0.001). Among patients with cirrhosis, 69% received one-time liver imaging. The proportion of follow-up time adherent to annual imaging was 0.39 (standard deviation 5 0.42), and the proportion was 0.28 (standard deviation 5 0.33) for biannual imaging; both proportions were higher in the specialty care group (all P < 0.05). Antiviral therapy (hazard ratio 5 0.85, 95% confidence interval 0.76-0.95, P 5 0.005) and liver imaging (hazard ratio 5 0.84, 95% confidence interval 0.76-0.91, P < 0.001) were independently associated with decreased mortality in adjusted analyses. Conclusion: We observed a low prevalence of recommended laboratory testing, antiviral therapy initiation, and liver imaging among a national cohort of veterans with hepatitis B infection; antiviral therapy and liver imaging were independently associated with decreased mortality. (HEPATOLOGY 2016;63:1774-1782 SEE EDITORIAL ON PAGE 1755A pproximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV). In the United States, the prevalence of chronic hepatitis B remains incompletely quantified, with estimates ranging from approximately 800,000 individuals to as high as 2.2 million when including foreign-born Americans. (1,2) Chronic HBV infection is a significant cause of morbidity and mortality, leading to liver failure, cirrhosis, and hepatocellular carcinoma (HCC) in 25%-40% of infected persons. (3) Specifically, in the United States, hepatitis B is the underlying cause of an estimated 1800-4000 deaths each year. (2,4) Despite the significant burden of disease and existence of management guidelines for the evaluation and treatment of chronic HBV, (5) studies have shown variable adherence to recommended HBV care, including low rates of alanine aminotransferase (ALT) and HBV DNA level monitoring and infrequent HCC surveillance. (6,7) Significant gaps i...

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“…187,199,200 This variation could reflect other factors, such as socioeconomic status, ethnicity and burden of illness. [201][202][203][204][205][206] Whether distance from a transplant center affects the chances of getting a transplant is uncertain, 206,207 but travelling to a distant center may not always benefit the patient. 208 …”

Section: Geography and The Provision Of Transplant Unitsmentioning

confidence: 99%