Racial Disparities in Pediatric Patients With Cholestatic Liver Disease Undergoing Liver Transplant: A UNOS Database...

Area of Science:

• Hepatology
• Transplantation Medicine
• Health Disparities Research

Background:

• Cholestatic liver disease is a primary indication for pediatric liver transplantation (LT).
• Socioeconomic factors, including racial disparities, can impede early detection and optimal care.
• This study investigates racial disparities in pediatric LT for cholestatic liver disease.

Purpose of the Study:

• To examine racial disparities in demographics, waitlist characteristics, and post-transplant outcomes.
• To identify differences in waitlist mortality, graft failure, and survival rates among racial groups.
• To inform targeted interventions for improving equity in pediatric LT.

Main Methods:

• Retrospective analysis of pediatric patients (≤18 years) listed or receiving LT for cholestatic liver disease (2010-2024).
• Data sourced from the United Network for Organ Sharing (UNOS) database.
• Outcomes stratified by race: non-Hispanic whites (NHW), non-Hispanic blacks (NHBs), Hispanics, and others.

Main Results:

• NHW recipients were more likely to have private insurance and shorter waitlist times.
• 1-year survival was lower in NHB recipients compared to NHW (94.8% vs. 96.8%).
• NHB recipients showed a significantly increased mortality risk (HR 1.53), with predictive modeling indicating higher mortality likelihood for NHB and Hispanic children.

Conclusions:

• Racial disparities significantly influence post-transplant outcomes in pediatric cholestatic liver disease.
• NHB and Hispanic children face elevated mortality risks despite comparable waitlist outcomes.
• Targeted interventions are crucial to promote equity in pediatric liver transplantation.