381 How Distance From Specialized Transplant Centers and Residence in Rural and Urban Setting Affects Outcome of Liver Transplant Patients on Waitlist in the USA

A S L D A b st ra ct s AIC optimization. Results: This cohort was 40% female with an average age of 58±9 years and average MELD score of 12±5. The etiology of liver disease was due to HCV in 78, alcohol in 49, and NASH in 66 patients. Of 193 patients, 75% reported pain-related disability based on any positive response. The median score on individual items ranging in severity from 0-10 was 3.0 (0.17, 5.83). In univariate testing, disability was strongly correlated with age, depression and anxiety symptoms, MELD score, pain severity, and levels of CRP, TNFα, and IL-6. Disability was also strongly related to the use of prescription opioids, with non-opioid users having median disability scores of 1.7 (iqr=0.0,4.7) on a scale of 0-10 and opioid users having median scores of 6.5 (iqr=4.5,7.8). Factors associated with higher levels of disability in the final model included MELD score (IRR for each point=1.03, 95% CI= 1.003,1.05), prescription opioid use (IRR=1.58, 95% CI=1.23,2.05), HADS score (IRR= 1.05, 95%CI=1.03,1.06), CRP (IRR=1.13 95%CI=1.04,1.24), and severity of pain (IRR=1.01, 95% CI=1.004,1.02). Conclusion: Self-reported pain-related disability is nearly universal in outpatients with cirrhosis, even in a group with relatively low MELD scores. Disability is most strongly related to opioid use, inflammation, mental health, pain, and severity of liver disease in this group. Interestingly, opioid use and inflammation appears to be more strongly associated with pain-related disability than severity of pain. This corresponds with prior publications demonstrating that opioid use is driven by factors other than pain and may decrease pain without improving overall function. Longitudinal studies are needed to determine whether opioid use marks or drives disability and whether the common use of these agents actually contributes to dysfunction.