Liver Transplantation for Biliary Atresia: Sex-Based Equity but Persistent Racial and Donor-Related Risk Factors

Liver transplantation can be salvage or primary therapy for children with biliary atresia. In this study, we investigated the effects of sex, race, and donor type on outcomes.

We used the United Network for Organ Sharing database to perform a retrospective analysis of 1382 pediatric transplant recipients with biliary atresia, in which we compared sex, race, and donor type using standard statistical tests. We analyzed graft failure and mortality with Kaplan -Meier and Cox regression.

No significant sex -based differences were found. Black (69.6 % ) and Hispanic (58.8 %) recipients primarily relied on public insurance (P <.001 ). Compared with non -Hispanic White recipients, Black recipients had higher Pediatric End-Stage Liver Disease scores (17.8 vs 14.4; P < .001 ), used living donors less (16.9 % vs 29.2 %; P = .004 ), and relied more on nationally shared organs (33.1 % vs 27.1 %; P = .026 ). Among deceased donor transplant recipients, total preservation time was significantly shorter for Non -Hispanic White recipients compared with recipients of other races (P = .010 ). For living donor transplant recipients, Black race (hazard ratio 10.91; P = .009 ) and increasing donor age (hazard ratio 1.09; P = .048 ) were significant independent risk factors for graft failure.

Disparities in disease severity, insurance, donor access, and logistics are critical considerations for equitable management of biliary atresia.