title: Racial and socioeconomic disparities in pediatric and young adult liver transplant outcomes.
abstract: Racial and socioeconomic disparities exist in liver transplantation (LT) outcomes among adults, but little research exists for pediatric LT populations. We examined racial differences in graft survival and mortality within a retrospective cohort of pediatric and young adult LT recipients at a large children's transplant center in the Southeast between 1998 and 2011. The association between race/ethnicity and rates of graft failure and mortality was examined with Cox proportional hazards models that were adjusted for demographic and clinical factors as well as individual-level and census tract-level socioeconomic status (SES). Among the 208 LT recipients, 51.0% were white, 34.6% were black, and 14.4% were other race/ethnicity. Graft survival and patient survival were higher for whites versus minorities 1, 3, 5, and 10 years after transplantation. The 10-year graft survival rates were 84% [95% confidence interval (CI) = 76%-91%] for white patients, 60% (95% CI = 46%-74%) for black patients, and 49% (95% CI = 23%-77%) for other race/ethnicity patients. The 10-year patient survival rates were 92% (95% CI = 84%-96%), 65% (95% CI = 52%-79%), and 76% (95% CI = 54%-97%) for the white, black, and other race/ethnicity groups, respectively. In analyses adjusted for demographic, clinical, and socioeconomic characteristics, the rates of graft failure [black: hazard ratio (HR) = 2.59, 95% CI = 1.29-5.45; other: HR = 3.01, 95% CI = 1.23-7.35] and mortality (black: HR = 4.24, 95% CI = 1.54-11.69; other: HR = 3.09, 95% CI = 0.78-12.19) were higher for minority groups versus whites. In conclusion, at a large pediatric transplant center in the Southeastern United States, racial/ethnic disparities exist in pediatric and young adult LT outcomes that are not fully explained by measured SES and clinical factors.
authors.affiliation: Emory University School of Medicine, Atlanta, GA; Department of Epidemiology, Rollins School of Public Health, Atlanta, GA.
authors.forename: Rekha V
authors.initials: RV
authors.lastname: Thammana
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: Rene
authors.initials: R
authors.lastname: Romero
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Heffron
authors.forename: Caroline T
authors.initials: CT
authors.lastname: Daniels
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005843:Geography; D006084:Graft Rejection / Q000208:ethnology; D006085:Graft Survival; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000208:ethnology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008913:Minority Groups; D016016:Proportional Hazards Models; D044469:Racial Groups; D012111:Residence Characteristics; D012189:Retrospective Studies; D012923:Social Class; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult