title: Disparities in liver transplantation: the association between donor quality and recipient race/ethnicity and sex.
abstract: BACKGROUND
  We aimed to examine the association between recipient race/ethnicity and sex, donor liver quality, and liver transplant graft survival.
  
  
  METHODS
  Adult non-status 1 liver recipients transplanted between March 1, 2002, and December 31, 2008, were identified using Scientific Registry of Transplant Recipients data. The factors of interest were recipient race/ethnicity and sex. Donor risk index (DRI) was used as a donor quality measure. Logistic regression was used to assess the association between race/ethnicity and sex in relation to the transplantation of low-quality (high DRI) or high-quality (low DRI) livers. Cox regression was used to assess the association between race/ethnicity and sex and liver graft failure risk, accounting for DRI.
  
  
  RESULTS
  Hispanics were 21% more likely to receive low-quality grafts compared to whites (odds ratio [OR]=1.21, P=0.002). Women had greater odds of receiving a low-quality graft compared to men (OR=1.24, P<0.0001). Despite adjustment for donor quality, African American recipients still had higher graft failure rates compared to whites (hazard ratio [HR]=1.28, P<0.001). Hispanics (HR=0.89, P=0.023) had significantly lower graft failure rates compared to whites despite higher odds of receiving a higher DRI graft. Using an interaction model of DRI and race/ethnicity, we found that the impact of DRI on graft failure rates was significantly reduced for African Americans compared to whites (P=0.02).
  
  
  CONCLUSIONS
  This study shows that while liver graft quality differed significantly by recipient race/ethnicity and sex, donor selection practices do not seem to be the dominant factor responsible for worse liver transplant outcomes for minority recipients.
authors.affiliation: 1 Section of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI. 2 Department of Biostatistics, University of Michigan, Ann Arbor, MI. 3 Food and Drug Administration, Silver Spring, MD. 4 Department of Surgery, University of Michigan, Ann Arbor, MI. 5 Arbor Research Collaborative for Health, Ann Arbor, MI. 6 Address correspondence to: Amit K. Mathur, M.D., M.S., 2922 Taubman Center, 1500 E Medical Center Dr, SPC 5300, Ann Arbor, MI 48109-5300.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Schaubel
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Mary K
authors.initials: MK
authors.lastname: Guidinger
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D002102:Cadaver; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006085:Graft Survival; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data