A geospatial analysis of liver transplant centers and alcohol-related liver disease across the United States

Alcohol-related liver disease (ARLD) represents a major cause of end-stage liver disease and has surged as a leading indication for liver transplantation. This study investigates geographic disparities in liver transplant center availability relative to the regional burdens of ARLD mortality and alcohol use disorder (AUD) prevalence in the U.S. Using state-level data from publicly available databases, we evaluated the relationships between liver transplant center density, ARLD mortality, and AUD prevalence. We also developed two novel metrics: the AUD prevalence-to-transplant recipients (AUDT) ratio and the ARLD deaths-to-transplant recipients (ARLDT) ratio. These ratios served as proxies for assessing disparities between the need for and access to liver transplant services. Our findings reveal that while AUD prevalence and AUDT ratios did not significantly vary with transplant center density, higher ARLD mortality per capita and ARLDT ratios were correlated with lower transplant center density. States without a transplant center also experienced significantly higher ARLD mortality per capita compared to states with at least one transplant center per 100,000 square miles. These findings underscore the significant role of geographic factors in accessing transplant care and suggest that barriers to transplant centers may contribute to outcome disparities among patients with ARLD. The study also highlights the need for targeted healthcare planning and policy interventions to enhance liver transplant access, particularly in regions with disproportionately high ARLD burdens and limited transplant infrastructure. Future research should utilize more granular geographies, such as transplant referral regions, and incorporate covariates related to overall healthcare infrastructure and access.