title: Geographic variation in organ availability is responsible for disparities in liver transplantation between Hispanics and Caucasians.
abstract: The aims of this study were to determine whether disparities in waiting list outcomes exist for Hispanics and African Americans during the post-MELD era, and to investigate interactions between disparities and geography. Scientific Registry of Transplant Recipients data were used to compare Hispanics and African Americans to Caucasians listed between 2003 and 2008. Endpoints included (i) receipt of a liver transplant and (ii) death or removal from the waiting list for being too sick or medically unsuitable. Adjustment for possible confounders was performed using multivariate Cox regression, with adjustment for geographic variation using a fixed-effects multilevel model. In multivariate analysis, African Americans have similar hazard of transplantation and death/removal as Caucasians during the post-MELD era. However, Hispanics are less likely to receive a transplant than Caucasians despite adjustment for potential confounders (HR 0.80, 95% CI 0.77-0.83), while having a similar hazard of death/removal. This effect disappeared after adjusting for unequal regional distribution of Hispanics, who represent 8% of patients in donation service areas (DSAs) having median waiting times of < or = 155 days versus 19% in DSAs with median waiting times of >155 days. In conclusion, disparities in liver transplantation exist for Hispanics during the post-MELD era, caused by geographic variation in organ availability.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. mvolk@med.umich.edu
authors.forename: M L
authors.initials: ML
authors.lastname: Volk
authors.forename: H
authors.initials: H
authors.lastname: Choi
authors.forename: G J W
authors.initials: GJ
authors.lastname: Warren
authors.forename: C J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: J A
authors.initials: JA
authors.lastname: Marrero
authors.forename: M
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000368:Aged; D005260:Female; D005843:Geography; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008107:Liver Diseases / Q000208:ethnology* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists; D044465:White People