Longer travel and traffic are associated with adult liver transplant waitlist mortality in the United States.

Transportation to transplant centers is a barrier to liver transplantation (LT). We analyzed the impact of travel metrics on LT waitlist outcomes in the United States. A total of 83 640 adult LT candidates in the Scientific Registry of Transplant Recipients database (2013-2021) were included. Google Distance Matrix application programming interface estimated driving time from patients' residing ZIP code to listing center. Effect of travel time (short [<1 hour], medium [1 to < 3 hours], or long [3 to < 6 hours]), traffic congestion in metropolitan areas, and center mismatch (defined as listing at a center >1 hour from nearest center) on waitlist mortality were examined using multivariable competing risk regression with adjustment for confounders. Compared to short travel, medium (HR 1.09 [95% CI: 1.05-1.13]) and long travel times (HR 1.14 [95% CI: 1.08-1.20]) were associated with higher waitlist mortality. Both high (HR 1.09 [95% CI: 1.01-1.12]) and moderate traffic (HR 1.09 [95% CI 1.02-1.15]) was also associated with higher waitlist mortality compared to low traffic. Lastly, there was no relationship between center mismatch (9.1% of listed) and waitlist deaths. Longer travel and traffic congestion are associated with greater waitlist mortality for adult LT candidates. Strategies to address these underrecognized spatial barriers to LT are needed.