Improving Access to Liver Care Across the Continuum of Care: Opportunities and Challenges

Liver transplantation has been established as the optimal therapy for patients with advanced end-stage liver disease (ESLD) (1). Effective pretransplant ESLD care, however, includes a continuum of services, including the management of hepatic encephalopathy, portal hypertension and hepatocellular carcinoma. Unfortunately, access to advanced liver care and transplantation remains highly variable across population subgroups and geography. Patients living in rural areas or who have lower socioeconomic status (SES) are less likely to be listed for and to receive liver transplants than urban residents or higher SES patients with similar severity of illness (2–4). This is due, in part, to the limited availability of subspecialty gastroenterology care in many communities (5).

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[9]  J. Schold,et al.  CMS oversight, OPOs and transplant centers and the law of unintended consequences , 2009, Clinical transplantation.

[10]  J. Tuttle-Newhall,et al.  Disparities in liver transplantation before and after introduction of the MELD score. , 2008, JAMA.

[11]  R. Merion,et al.  Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas. , 2008, JAMA.

[12]  D. E. Schaubela,et al.  The Survival Benefit of Deceased Donor Liver Transplantation as a Function of Candidate Disease Severity and Donor Quality , 2008 .