title: Racial and ethnic disparities in access to and utilization of living donor liver transplants.
abstract: Living donor liver transplantation (LDLT) is a comparable alternative to deceased donor liver transplantation and can mitigate the risk of dying while waiting for transplant. Although evidence exists of decreased utilization of living donor kidney transplants among racial minorities, little is known about access to LDLT among racial/ethnic minorities. We used Organ Procurement and Transplantation Network/United Network for Organ Sharing data from February 27, 2002 to June 4, 2014 from all adult liver transplant recipients at LDLT-capable transplant centers to evaluate differential utilization of LDLTs based on race/ethnicity. We then used data from 2 major urban transplant centers to analyze donor inquiries and donor rule-outs based on racial/ethnic determination. Nationally, of 35,401 total liver transplant recipients performed at a LDLT-performing transplant center, 2171 (6.1%) received a LDLT. In multivariate generalized estimating equation models, racial/ethnic minorities were significantly less likely to receive LDLTs when compared to white patients. For cholestatic liver disease, the odds ratios of receiving LDLT based on racial/ethnic group for African American, Hispanic, and Asian patients compared to white patients were 0.35 (95% CI, 0.20-0.60), 0.58 (95% CI, 0.34-0.99), and 0.11 (95% CI, 0.02-0.55), respectively. For noncholestatic liver disease, the odds ratios by racial/ethnic group were 0.53 (95% CI, 0.40-0.71), 0.78 (95% CI, 0.64-0.94), and 0.45 (95% CI, 0.33-0.60) respectively. Transplant center-specific data demonstrated that African American patients received fewer per-patient donation inquiries than white patients, whereas fewer African American potential donors were ruled out for obesity. In conclusion, racial/ethnic minorities receive a disproportionately low percentage of LDLTs, due in part to fewer initial inquiries by potential donors. This represents a major inequality in access to a vital health care resource and demands outreach to both patients and potential donors.
authors: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Yael R
authors: YR
authors: Nobel
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors: Kimberly A
authors: KA
authors: Forde
authors: Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors: Linda
authors: L
authors: Wood
authors: Department of Surgery, School of Medicine, Yale University, New Haven, CT.
authors: Katarzyna
authors: K
authors: Cartiera
authors: Department of Surgery, School of Medicine, Yale University, New Haven, CT.
authors: Armando S
authors: AS
authors: Munoz-Abraham
authors: Department of Surgery, School of Medicine, Yale University, New Haven, CT.
authors: Peter S
authors: PS
authors: Yoo
authors: Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors: Peter L
authors: PL
authors: Abt
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
authors: David S
authors: DS
authors: Goldberg
mesh_terms: D001741:Black or African American; D001213:Asian; D002779:Cholestasis / Q000208:ethnology / Q000601:surgery; D005006:Ethnicity; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D016030:Kidney Transplantation; D017093:Liver Failure / Q000208:ethnology* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement; D014481:United States; D014850:Waiting Lists