Racial and ethnic disparities in liver transplant access vary within and across transplant referral regions.

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Tác giả: Arrey-Takor Ayuk-Arrey, Juan Carlos Caicedo, Lauren Nephew, Katherine Ross-Driscoll

Ngôn ngữ: eng

Ký hiệu phân loại: 636.0885 Animal husbandry

Thông tin xuất bản: United States : Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 176697

Prior studies have demonstrated racial disparities in access to liver transplantation, but the determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients and the National Center for Health Statistics from 2015 to 2021. The primary outcome was the difference in the listing-to-end-stage liver disease death ratio between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, health care access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower listing-to-end-stage liver disease death ratios than White patients in 80% of TRRs, while Hispanic patients had equal or higher listing-to-end-stage liver disease death ratios compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.
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