Prolonged travel time to transplantation center is associated with poor outcomes following heart transplantation

Abstract

Background: This study aims to examine the impact of home-to-transplantation center travel time as a potential barrier to healthcare accessibility.

Methods: Observational study examined adult heart transplant recipients who received a graft between 2012 and 2022 in the United States. Travel time was calculated using the Google Distance Matrix API between the recipient's residence and transplantation center. A multivariable parametric survival model was fitted to minimize confounding bias.

Results: Among the 25,923 recipients that met the selection criteria, the median travel time was 51 ​min and 95 ​% of recipients lived within a 5-h radius of their center. White recipients experienced longer median travel times (62 ​min, p ​< ​0.001) compared to Black (36 ​min) or Hispanic (40 ​min) recipients. A travel time of 1-2 ​h (survival time ratio [STR] 0.867, p ​= ​0.035) or >2 ​h (STR 0.873, p ​= ​0.026) away from the transplantation center was independently associated with lower long-term survival rates.

Conclusion: Extended travel times to transplantation centers may negatively impact long-term survival outcomes for heart transplant recipients, suggesting the need to address this potential barrier to healthcare accessibility.

Keywords: Heart transplantation; Social determinants of health; Travel time.