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PATIENT TRAVEL DISTANCE AND POST LUNG TRANSPLANT MORTALITY OUTCOMES

      TOPIC: Transplantation
      TYPE: Original Investigations
      PURPOSE: The regionalization of lung transplant care offers patients access to experienced clinical teams in the peri-operative time period. However, after transplant recipients often must travel a wide range of distances to regularly return to the transplant center for longitudinal outpatient care. It is unknown whether patient travel distance from residential zip code to transplant center is associated with causes of post-transplant mortality, specifically graft failure. We hypothesized an association between graft failure and patient travel distance would suggest differences in healthcare delivery by distance from center.
      METHODS: Retrospective single center cohort study of adult (≥18 years) first time lung only recipients transplanted between January 1, 2009 through December 31, 2019. Data extracted from the electronic health records include demographic and clinical characteristics, linear distance from residential zip code to transplant center, time to and cause of mortality. Primary causes of mortality were regularly adjudicated and recorded by clinicians of the transplant program.
      RESULTS: 1202 patients met inclusion criteria. Average age at time of transplant was 61 years, 402 (33%) were female, and fibrotic lung disease was the most common indication for transplant, 737 (61%). Travel distance quartiles were <54.1 miles, 54.2-150.1 miles, 150.2-241.9 miles, and >242.0 miles (n = 295 each quartile). The two leading causes of death were infection and graft failure (e.g. acute and chronic rejection), followed by cardiovascular (including myocardial infarction or stroke), pulmonary (including Acute Respiratory Distress Syndrome or pulmonary embolism), malignancy, and other causes. There was no association between patient travel distance and survival after transplant in multivariate survival analysis (p = 0.72), nor was there an association with cause of death in multinomial logistic regression (p = 0.54) after adjusting for sex, race, age, native lung disease category, single vs bilateral transplant, and lung allocation score at time of transplant.
      CONCLUSIONS: In this large single center study, patient travel distance from permanent residential zip code to transplant center was not associated with graft failure as a cause of mortality.
      CLINICAL IMPLICATIONS: Regionalization of lung transplant care can offer improved access and peri-operative outcomes for patients. Our study demonstrated that patient travel distance was not associated with causes of post-transplant mortality, suggesting that long term care delivery after lung transplant was not adversely impacted by distance from transplant center. Cause of mortality is one approach to understanding healthcare delivery patterns. Our findings need to be examined in a multi-center cohort and consider additional outcomes such as quality of life measures.
      DISCLOSURES: No relevant relationships by Olufemi Akindipe, source=Web Response
      No relevant relationships by Marie Budev, source=Web Response
      No relevant relationships by Shruti Gadre, source=Web Response
      No relevant relationships by Charles Lane, source=Web Response
      No relevant relationships by Carli Lehr, source=Web Response
      No relevant relationships by Manshi Li, source=Web Response
      No relevant relationships by Atul Mehta, source=Web Response
      No relevant relationships by Wayne Tsuang, source=Web Response
      No relevant relationships by Jason Turowski, source=Web Response
      No relevant relationships by Xiaofeng Wang, source=Web Response