A pilot randomized controlled trial of a transportation assistance program in liver transplant (TAP-LT) candidates

BACKGROUND: Access to transportation is a key social determinant of health outcomes and a required component of liver transplant eligibility. We assessed feasibility, acceptability, and preliminary effectiveness of a transportation assistance program among at-risk liver transplant candidates (TAP-LT) in a pilot randomized controlled trial. 

METHODS: Adult participants were recruited from a single urban high-volume transplant center at an initial LT evaluation clinic visit in 2022. Included participants either reported transportation barriers on a screening survey or were Medicaid-insured. Participants were randomized 1:1 to intervention (Lyft rideshares to any healthcare-related visit) or control (usual care) arms with study end at time of listing decision. 

RESULTS: 42 LT candidates were enrolled in the TAP-LT trial (N=21 per arm) with an 78.6% retention rate. Median age was 56 years (IQR 47-62), 61.9% were male, 85.7% Hispanic, and 81.0% had Medicaid. Nine (42.9%) of 21 intervention participants completed a Lyft ride with a median number of 8 (4-18) rides per rider; 89.6% of ordered rides were completed. At end of study, patient satisfaction with medical care assessed by the RAND PSQ-18 was high in both arms. 100% of intervention participants reported being more likely to attend medical visits because of the TAP-LT program and there were no safety concerns. 10 in the intervention vs 6 in the control arm were listed (p=0.37); median time to waitlisting was 131 days (42-228) and did not differ by study arm (p=0.79). 

CONCLUSION: Our pilot trial demonstrates Lyft rideshares to be feasible and highly acceptable to LT candidates (ClinicalTrials.gov, Number NCT05080595), supporting conduct of a larger efficacy trial.