Leal-Leyte P, Rodriguez-Payan N, Cote MP, Noriega-Salas L, Lugo-Baruqui A, Dageforde LA, Zamora-Valdés D. Geographical disparities for liver transplantation access in Mexico. World J Transplant 2025; 15(4): 111427 [DOI: 10.5500/wjt.v15.i4.111427]
Corresponding Author of This Article
Daniel Zamora-Valdés, MD, MSc, FACS, Department of Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City - Riyadh, 6817, 2878, Ar Rimayah Kasch, Riyadh 14611, Riyadh, Saudi Arabia. valdesda1@mngha.med.sa
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Transplantation
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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World Journal of Transplantation
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2220-3230
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Leal-Leyte P, Rodriguez-Payan N, Cote MP, Noriega-Salas L, Lugo-Baruqui A, Dageforde LA, Zamora-Valdés D. Geographical disparities for liver transplantation access in Mexico. World J Transplant 2025; 15(4): 111427 [DOI: 10.5500/wjt.v15.i4.111427]
World J Transplant. Dec 18, 2025; 15(4): 111427 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.111427
Geographical disparities for liver transplantation access in Mexico
Pilar Leal-Leyte, Natalia Rodriguez-Payan, Maria P Cote, Lorena Noriega-Salas, Alejandro Lugo-Baruqui, Leigh-Anne Dageforde, Daniel Zamora-Valdés
Pilar Leal-Leyte, Department of Organ Transplantation, Navy Medical Center, Mexico City 04470, Mexico
Natalia Rodriguez-Payan, Maria P Cote, Leigh-Anne Dageforde, Department of Transplant Surgery, Massachussetts General Hospital, Boston, MA 02114, United States
Lorena Noriega-Salas, Departamento de Trasplantes, Hospital De Especialidades "Dr. Antonio Fraga Mouret", Mexico City 02990, Mexico
Alejandro Lugo-Baruqui, Department of Transplant, Hospital Ángeles del Carmen, Guadalajara 44670, Jalisco, Mexico
Daniel Zamora-Valdés, Department of Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City - Riyadh, Riyadh 14611, Riyadh, Saudi Arabia
Author contributions: Leal-Leyte P and Zamora-Valdés D contributed to the design and implementation of the research; Zamora-Valdés D analyzed the data; Leal-Leyte P, Rodriguez-Payan N, Cote MP, Noriega-Salas L, Lugo-Baruqui A, Dageforde LA and Zamora-Valdés D, wrote the manuscript; Dageforde LA and Zamora-Valdés D supervised the study.
Institutional review board statement: All information contained in this study was de-identified and publicly available. The study was approved by our local committee (MGH).
Informed consent statement: This study is based on publicly-available databases with no access to data identity.
Conflict-of-interest statement: No affiliations with or involvement in any organization or entity with any financial interest to disclose.
Data sharing statement: This study is based on publicly available databases.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Zamora-Valdés, MD, MSc, FACS, Department of Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City - Riyadh, 6817, 2878, Ar Rimayah Kasch, Riyadh 14611, Riyadh, Saudi Arabia. valdesda1@mngha.med.sa
Received: July 1, 2025 Revised: July 25, 2025 Accepted: September 2, 2025 Published online: December 18, 2025 Processing time: 143 Days and 6 Hours
Abstract
BACKGROUND
Liver disease is a major cause of mortality in Mexico. Liver transplantation (LT) remains severely limited, and there are no reports on equity of access.
AIM
To analyze geographical disparities in LT access in Mexico.
METHODS
LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed. LT listings per million persons (pmp) were calculated. Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000. LT and waitlist mortality was calculated as 90-day rate, overall rate and rate per 100 person-years. We compared access to waitlist, transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.
RESULTS
There were 2600 new waitlist registrations; 1572 registrations (60.4%) living in Mexico City and State, Jalisco and Nuevo Leon. There were 1755 LT; 92.5% of them performed in States with higher LT activity, and 1101 (62.7% vs 37.3%; P < 0.001) done in patients living in those States. Listings pmp in the Mexican States with high LT activity were 3.8, 1.5 vs 1.2, 0.6 (P < 0.001); observed-to-expected listings were 1.3, 0.4 vs 0.4, 0.2 (P < 0.001); LT pmp were 2.7, 0.9 vs 0.7, 0.5 (P < 0.001). After controlling for other variables, patients living in high LT activity States had a HR 1.14 (95%CI: 1.03-1.26; P = 0.009) to be a case of transplantation after listing.
CONCLUSION
Geographic disparities substantially affect LT access in Mexico. The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT. Current referral system, and resource allocation need urgent revision to remove the barriers associated with geographic disparity.
Core Tip: Geographic disparities substantially affect liver transplantation (LT) access in Mexico. The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.
