Study Highlights Racial, Ethnic Disparities in Liver Transplant Waitlisting, Allocation

Findings from a recent study are calling attention to significant disparities in waitlist removal and receipt of liver transplant among patients with end-stage liver disease (ESLD) due to steatotic liver disease (SLD).¹

The research was presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, by Shyam Patel, MD, an internal medicine resident at California Pacific Medical Center, and highlights significant racial/ethnic inequities in liver transplant waitlist outcomes.¹

According to the United Network for Organ Sharing (UNOS), more than 103,000 people in the US are currently on the national transplant waitlist, with liver transplant being the second most sought after transplant following kidney transplant.^2-

To assess disparities in patient outcomes among adults with ESLD due to SLD awaiting liver transplantation, investigators leveraged 2010-2023 UNOS registry data for adults ≥ 18 years of age with non-hepatocellular carcinoma ESLD listed for transplant. They evaluated adjusted probabilities of waitlist removal due to death or being too sick and receipt of liver transplant within 3 years of listing using competing-risks Cox proportional hazards models and Kaplan Meier methods.¹

In total, investigators identified 54,355 adults with ESLD from SLD awaiting liver transplantation. Among the cohort, the median age was 56 (Interquartile range [IQR], 48-62) years and the majority of patients were male (63%) and non-Hispanic White (77%) with alcohol-associated liver disease (ALD; 60.8%).¹

Overall, the median time to waitlist removal or receipt of liver transplant was 152 (IQR, 28-513) days and 30 (IQR, 7-136) days, respectively.¹

Investigators observed a significantly greater risk of waitlist removal among Hispanic patients compared with non-Hispanic White patietns (14.7% vs 11.0%; adjusted hazard ratio [aHR], 1.35; 95% CI, 1.27-1.44; P <.05). They noted similar trends when assessing patients with metabolic dysfunction-associated steatohepatitis (MASH) and ALD separately, with significantly greater risk of waitlist removal observed among Hispanic patients (MASH aHR, 1.24; 95% CI, 1.13-1.37; ALD aHR, 1.40; 95% CI, 1.27-1.53; both P <.05).¹

When assessing the probability of liver transplantation, compared to non-Hispanic White patients, significantly lower odds of transplant were observed among African American patients (aHR, 0.86; 95% CI, 0.79-0.93); Asian/Pacific Islander patients (aHR, 0.88; 95% CI, 0.80-0.97); American Indian/Alaska Native patients (aHR, 0.82; 95% CI, 0.72-0.93); and Hispanic patients (aHR, 0.83; 95% CI, 0.80-0.86) (all P <.05).¹

When examining patients with MASH, the probability of transplant was significantly reduced among Hispanic patients (aHR, 0.82; 95% CI, 0.78-0.87; P <.05). Among patients with ALD, the probability of transplant was significantly lower among African American patients (aHR, 0.87; 95% CI, 0.80-0.98); Asian/Pacific Islander patients (aHR, 0.86; 95% CI, 0.76-0.98); American Indian/Alaska Native patients (aHR, 0.80; 95% CI, 0.68-0.93); and Hispanic patients (aHR, 0.83; 95% CI, 0.79-0.87) (all P <.05).¹

“Significant racial/ethnic disparities in liver transplant waitlist outcomes were observed among adults with ESLD due to SLD, particularly among Hispanics and African Americans,” investigators concluded.¹ “Better understanding and addressing modifiable barriers to equitable liver transplant care is needed to address existing disparities.”

References

1. ^{Patel Z, Zhang W, Singal A, et al. Significant Racial/Ethnic Disparities in Liver Transplant Waitlist Outcomes Among U.S. Adults with End-Stage Liver Disease Due to Steatotic Liver Disease. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}
2. ^{Health Resources and Services Administration. Organ Donation Statistics. October 2024. Accessed November 17, 2024. https://www.organdonor.gov/learn/organ-donation-statistics}