Disparity in Transplant Referral Patterns for Alcohol-Related Liver Disease Based on Physician-Dependent Variables.

INTRODUCTION: Distance from a liver transplant (LT) center does not affect post-transplant outcomes. Rural areas have lower rates of listing and receiving solid organ transplants. The aim of this study was to investigate trends in referral for LT based on physician-dependent variables. METHODS: An online survey was distributed to a cohort of physicians. Questions pertained to physician demographics, including age, specialty, practice location, and training at an LT center. Distances to the nearest transplant center was calculated based on zip code. Variables studied included length of sobriety, patient age, and body mass index required for transplant evaluation. Responses were analyzed using univariate ordinal logistic regression models and multivariable analyses. RESULTS: In the study, 299 physician respondents were analyzed. Physicians without LT center training were 2.05 (confidence interval [CI] 1.33-3.17) times more likely to require longer duration of sobriety. As distance increased from a transplant center, the odds of requiring longer sobriety increased by 1.43 (CI 1.11-1.83) times. Gastroenterologists (GIs) and transplant hepatologists (THs) showed significant differences in referral candidacy for patients with alcohol-related liver disease (P < .0001). When compared to GIs/THs, primary care physicians were 2.11 times (CI 0.97-4.58) more likely to require a longer duration of sobriety. No significant physician-dependent variables were found in respect to patient age or body mass index. DISCUSSION: Our study demonstrates that physician-dependent variables exist in referral for transplant evaluation. GIs and THs were more likely to refer higher-risk patients, which suggests a disparity in referral of patients with alcohol-related liver disease to transplantation depending on access to subspecialty care.

Colonic Polypoid Arteriovenous Malformation Causing Symptomatic Anemia.

Vascular ectasias, which can be classified as angiodysplasias and arteriovenous malformations (AVMs), accounts for approximately 3% of lower gastrointestinal bleeding. Typically, colonic AVMs are solitary, large, and flat or elevated red lesions on endoscopy. We present an interesting case of a polypoid ulcerated AVM in the transverse colon causing symptomatic anemia, which was resected endoscopically with a resolution of symptoms. Polypoid colonic AVMs are rather rare with only 15 other cases described in the literature. This case highlights the approach to endoscopic management of these lesions.