# Identifying determinants of access to the early steps of liver transplant in the Southeast

> **NIH NIH K01** · EMORY UNIVERSITY · 2023 · $1

## Abstract

Project Summary / Abstract
Cirrhosis is a major public health problem in the United States, affecting approximately 4.5 million people with
increased prevalence among persons living in poverty and insured by Medicaid. Decompensated cirrhosis,
also called end-stage liver disease (ESLD), occurs when patients begin to experience major complications of
cirrhosis, including ascites, variceal bleeding, and encephalopathy, with ~200,000 incident cases and 50,000
deaths in the U.S. each year. For patients with ESLD, liver transplant is the only curative treatment option. In
2021, there were approximately 9,000 liver transplants in the U.S. Transplantation is a complex, multistep
process that begins at ESLD diagnosis and requires referral to a highly specialized transplant center. This is
followed by completion of an intense, holistic medical and psychosocial evaluation process, and, if selected,
being placed on the national waiting list for a deceased donor liver. Once patients are waitlisted, they are
surveilled by the United Network for Organ Sharing (UNOS), which monitors equity in access to transplantation
for patients on the deceased donor waiting list in addition to post-transplant outcomes. While access to liver
transplant once waitlisted is relatively equitable, there are racial, socioeconomic, and geographic disparities in
waitlisting. Because of data limitations, potential disparities in earlier steps to liver transplant (i.e. referral and
evaluation) that may lead to observed differences in waitlisting remain unknown. Using data from two liver
transplant centers serving a 108-county region in Georgia, Alabama, Tennessee and South Carolina served by
Emory and Piedmont (Atlanta catchment area), combined with patient and provider interviews, the proposed
application will identify key factors that influence access to liver transplant referral and evaluation for ESLD
patients in the Southeast. This work will inform a future R01 application to develop and test an intervention to
increase equity in access to the early steps of liver transplant in this region. The mentoring team, Drs. Rachel
Patzer (primary mentor), Dio Kavalieratos (co-mentor) and Raymond Lynch (co-mentor), represent a combined
wealth of expertise in transplant epidemiology, clinical liver transplantation, health services research, and
qualitative and mixed methods research. Through the training provided by this K01, Dr. Ross-Driscoll will
obtain additional knowledge of clinical aspects of liver transplantation, and methodological skills in spatial
epidemiology, qualitative research and intervention development. The combination of research and training
support provided by this K01 award will allow her to build on her previous experience in liver transplantation,
epidemiology, and health services research to become an expert in the field of liver transplant access.

## Key facts

- **NIH application ID:** 10644293
- **Project number:** 1K01MD018455-01
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Katie Ross-Driscoll
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $1
- **Award type:** 1
- **Project period:** 2023-07-20 → 2023-08-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10644293

## Citation

> US National Institutes of Health, RePORTER application 10644293, Identifying determinants of access to the early steps of liver transplant in the Southeast (1K01MD018455-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10644293. Licensed CC0.

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