Short- and Long-Term Outcomes for Ethnic Minorities in the United States After Liver Transplantation: Parsing the Hispanic Paradox

Althoff, Ashley; Ali, Mohammad Shadab; O’Sullivan, David; Dar, Wasim; Emmanuel, Bishoy; Morgan, Glyn; Einstein, Michael; Richardson, Elizabeth; Sotil, Eva U.; Swales, Colin; Sheiner, Patricia A.; Serrano, Oscar K.

doi:10.1016/j.transproceed.2022.08.038

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Lee et al [23] in a retrospective analysis of UNOS registry found a higher probability of age-adjusted mortality and risk of mortality in Black patients when compared to White patients; ALD was one of the strongest identified mediators of the observed racial disparities. Althoff et al [24] reinforced this finding, but also noted improved 1- and 5-year patient and graft survival for Hispanic patients compared to White patients, consistent with a phenomenon called the Hispanic-paradox. The Hispanic-paradox remains a topic of interest for some studies, in which researchers identified that despite greater disease severity and lower access to care within the Hispanic population, those who received LT demonstrated significantly better short- and long-term outcomes compared to their Black and White counterparts [23].…”

Section: Inequities In Post Liver Transplantation Outcomesmentioning

confidence: 84%

Equity in liver transplantation: are we any closer?

Ogundolie,

Chan,

McElroy

2023

Current Opinion in Organ Transplantation

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Purpose of review As policies governing liver transplantation (LT) continue to change and influence clinical practice, it is important to monitor trends in equitable access and outcomes amongst patients. The purpose of this review is to closely examine recent advances and findings in health equity research in LT over the last 2 years; specifically evaluating inequities at the different stages of LT (referral, evaluation, listing, waitlist outcomes and post-LT outcomes). Recent findings Advancements in geospatial analysis have enabled investigators to identify and begin to study the role of community level factors (such as neighborhood poverty, increased community capital/urbanicity score) in driving LT disparities. There has also been a shift in investigating center specific characteristics that contributes to disparities in waitlist access. Modification to the current model for end stage liver disease (MELD) score policy accounting for height differences is also crucial to eradicating the disparity in LT amongst sexes. Lastly, Black pediatric patients have been shown to have higher rates of death and worse posttransplant outcome after transitioning to adult healthcare. Summary Although, there have been some advances in methodology and policies, inequities in waitlist access, waitlist outcomes and posttransplant outcomes continue to be pervasive in the field of LT. Future directions include expansion of social determinants of health measures, inclusion of multicenter designs, MELD score modification and investigation into drivers of worse posttransplant outcomes in Black patients.

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Section: Inequities In Post Liver Transplantation Outcomesmentioning

confidence: 84%

Equity in liver transplantation: are we any closer?

Ogundolie,

Chan,

McElroy

2023

Current Opinion in Organ Transplantation

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“…Black patients and those living in high-poverty neighborhoods have greater delays in hepatocellular carcinoma care and worse survival [13]. Women and Black patients have lower access to liver transplantation in the setting of ALD and Black patients who ultimately undergo liver transplantation have worse graft survival and overall survival [14,15].…”

Section: Introductionmentioning

confidence: 99%

Preferred language and disease severity predict evaluation for liver transplantation among patients admitted with alcohol-associated hepatitis

Cloonan

Broekhuis

Coe

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background: Liver transplantation (LT) for alcohol-associated hepatitis (AH) is a relatively new practice and limited work exists surrounding the role social determinants of health may play in evaluation. This includes language that defines how patients interact with the healthcare system. We explored characteristics of patients with AH evaluated for LT within an integrated health system. Methods Using a system-wide registry, we identified admissions for AH from 1 January 2016 to 31 July 2021. A multivariable logistic regression model was developed to evaluate independent predictors of LT evaluation. Results Among 1723 patients with AH, 95 patients (5.5%) underwent evaluation for LT. Evaluated patients were more likely have English as their preferred language (95.8% vs 87.9%, P = 0.020), and had higher INR (2.0 vs 1.4, P < 0.001) and bilirubin (6.2 vs 2.9, P < 0.001). AH patients who underwent evaluation had a lower burden of mood and stress disorders (10.5% vs 19.2%, P < 0.05). Patients with English preferred language had a greater than three times adjusted odds of LT evaluation compared with all others when adjusting for clinical disease severity, insurance status, sex, and psychiatric comorbid conditions (OR, 3.20; 95% CI, 1.14–9.02). Conclusion Patients with AH evaluated for LT were more likely to have English as their preferred language, more psychiatric comorbidities, and more severe liver disease. Despite adjustment for psychiatric comorbidities and disease severity, English preferred language remained the strongest predictor of evaluation. As programs expand LT for AH, it is vital to build equitable systems that account for the interaction between language and healthcare in transplantation.

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“…Despite efforts to reduce disparities in LT, such as the Share 35 policy, split liver transplant, or the increasing utilization of living donor LTs, there is still a significant gap in access and outcomes among different racial groups . It is well known that Latinx/o/a and Black or African American patients are less frequently referred to LT centers and have a lower chance of getting on the waiting list for LT .…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change

Saberi,

Gurakar,

Tamim

et al. 2023

JAMA Netw Open

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ImportanceRacial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment.ObjectiveTo quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors.Design, Setting, and ParticipantsThis cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021. Participants were adult patients with HCC on the LT waiting list and those who received LT. Data were analyzed from March 2022 to September 2023.ExposuresRace and time before and after the 2015 OPTN policy change.Main Outcomes and MeasuresProportion of LT from wait-listed candidates, the proportion of waiting list removals, and mortality after LT.ResultsAmong 12 031 patients wait-listed for LT with HCC (mean [SD] age, 60.8 [7.4] years; 9054 [75.3%] male; 7234 [60.1%] White, 2590 [21.5%] Latinx/o/a, and 1172 [9.7%] Black or African American), this study found that after the 2015 model of end-stage liver disease (MELD) exception policy changes for HCC (era 2), the overall proportion of LT for HCC across all races decreased while the proportion of dropouts on the LT waiting list remained steady compared with patients who did not have HCC. In Kaplan-Meier analysis, Asian patients demonstrated the lowest dropout rates in both era 1 and era 2 (1-year dropout, 16% and 17%, respectively; P &lt; .001). In contrast, Black or African American patients had the highest dropout rates in era 1 (1-year dropout, 24%), but comparable dropout rates (23%) with White patients (23%) and Latinx/o/a patients in era 2 (23%). In both eras, Asian patients had the highest survival after LT (5-year survival, 82% for era 1 and 86% for era 2), while Black or African American patients had the worst survival after LT (5-year survival, 71% for era 1 and 79% for era 2). In the multivariable analysis for HCC LT recipients, Black or African American race was associated with increased risk of mortality in both eras, compared with White race (HR for era 1, 1.17; 95% CI, 1.05-1.35; and HR for era 2, 1.31; 95% CI, 1.10-1.56).Conclusions and RelevanceThis cohort study of LT candidates in the US found that after the 2015 MELD exception policy change for HCC, the proportion of LT for HCC had decreased for all races. Black or African American patients had worse outcomes after LT than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates.

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Short- and Long-Term Outcomes for Ethnic Minorities in the United States After Liver Transplantation: Parsing the Hispanic Paradox

Cited by 4 publications

References 21 publications

Equity in liver transplantation: are we any closer?

Equity in liver transplantation: are we any closer?

Preferred language and disease severity predict evaluation for liver transplantation among patients admitted with alcohol-associated hepatitis

Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change

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