Racial disparities in posttransplant outcomes among recipients undergoing simultaneous liver-kidney transplantation

Patients with end-stage cirrhosis may experience renal dysfunction, necessitating a simultaneous kidney-liver transplant (SKLT). Guidelines have been put forth by the United Network for Organ Sharing (UNOS) to streamline the SKLT allocation process and ensure equitable access to transplantation. However, there is a scarcity of literature on racial and ethnic disparities in post-SKLT outcomes.

The UNOS Standard Transplant Analysis and Research Database was queried from 2005 to 2019 to study SKLT patients. Patients were stratified by race: White (reference group) recipients ( n  = 3513), Black recipients ( n  = 859), Hispanic recipients ( n  = 964), Asian recipients ( n  = 206), and other recipients ( n  = 85). Primary endpoints included all-cause mortality and graft failure while secondary endpoints were specific causes of death.

Hispanic recipients had a lower risk of all-cause mortality (aHR: 0.79, 95% CI: 0.68-0.93, P  = 0.003), while Black recipients had a significantly increased risk of graft failure compared to Whites (aHR: 1.63, 95% CI: 1.16-2.30, P  = 0.005). Evaluation of specific causes of recipient death revealed a higher risk of death due to gastrointestinal hemorrhage among Blacks (aHR: 4.16, 95% CI: 1.04-16.68, P  = 0.04).

Our study findings show Black patients experience higher rates of graft failure compared to White counterparts. The reasons for these disparities are not fully understood but likely a combination of biological and social factors. Further investigation is warranted to ascertain the specific factors influencing these outcomes.