Racial Disparities in Pediatric Patients With Cholestatic Liver Disease Undergoing Liver Transplant: A UNOS Database
Ahmad Anouti1, Hamza Dahshi2, Elias D Rady3
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Racial disparities impact pediatric liver transplantation (LT) outcomes for cholestatic liver disease. Non-Hispanic Black and Hispanic children experience higher mortality risks post-LT, necessitating targeted interventions for equitable care.
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.
Introduction:
Cholestatic liver disease is the leading indication for pediatric liver transplantation (LT). Early detection and optimal care are often limited by socioeconomic barriers including racial disparities. This study examined racial disparities in demographics, waitlists, and post-transplant outcomes among pediatric LT recipients with cholestatic liver disease.
Methods:
All pediatric patients (≤ 18 years) who were listed or received LT for cholestatic liver disease (Biliary Atresia, Caroli's, Choledochal cyst, PSC, PFIC, Alagille, and other non-specified cholestatic diseases) between 2010 and 2024 were retrospectively identified using the United Network for Organ Sharing (UNOS) database. The primary outcome of the study was waitlist mortality, graft failure, and post-transplant mortality stratified by race, specifically non-Hispanic whites (NHW), non-Hispanic blacks (NHBs), Hispanics, and others.
Results:
3501 pediatric patients underwent LT for cholestatic liver disease: 1663 (47.5%) were NHW, 795 (22.7%) were Hispanic, 648 (18.5%) were NHB, and 395 (11.3%) were of other races. NHW recipients were more likely to have private insurance (56.7% vs. 18.2%, p < 0.01) and experienced shorter waitlist times than Hispanic patients (175.9 vs. 189.4 days, p < 0.01). The 1-year survival rate was lower in NHB than in NHW recipients (94.8% vs. 96.8%, p = 0.04), with no significant difference at 5 years (93.7% vs. 95.4%, p = 0.13). Hispanic patients had similar 1-year (95.9%, p = 0.26) and 5-year (93.3%, p = 0.06) survival rates to NHW. NHB recipients had a significantly increased risk of mortality with a hazard ratio (HR) of 1.53 [95% CI: 1.05-2.22]. Predictive modeling using extreme gradient boosting showed a relative likelihood of increased mortality in NHB (3.91%) and Hispanic (3.14%) recipients.
Conclusion:
Racial disparities significantly affect post-transplant outcomes in pediatric cholestatic liver disease. NHB and Hispanic children face a risk of higher mortality despite similar waitlist outcomes, highlighting the need for targeted interventions to promote equity in pediatric liver transplantation.
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