Racial and Socioeconomic Disparities in Pediatric and Young Adult Liver Transplant Outcomes

• Type of Material: Article
• Authors: Rekha V. Thammana, Emory University; Stuart Knechtle, Emory University; Rene Romero, Emory University; Thomas G. Heffron, Porter Adventist Hospital; Caroline T. Daniels, Childrens Hospital Atlanta; Rachel Patzer, Emory University
• Language: English
• Date: 2014-01-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 AASLD. © 2013 American Association for the Study of Liver Diseases.
• Final Published Version (URL): http://dx.doi.org/10.1002/lt.23769
• Title of Journal or Parent Work: Liver Transplantation
• ISSN: 1527-6465
• Volume: 20
• Issue: 1
• Start Page: 100
• End Page: 115
• Grant/Funding Information: Patzer was also supported in part by the National Institute on Minority Health and Health Disparities (1R24MD008077-01).; Rachel E. Patzer was supported in part by grants from the National Center for Advancing Translational Sciences of the National Institutes of Health (awards ULl TR000454 and KL2TR000455).
• Keywords: BILIARY ATRESIA; US; Life Sciences & Biomedicine; Surgery; ACCESS; Transplantation; NEIGHBORHOOD DEPRIVATION; QUALITY-OF-LIFE; CHILDREN; HEALTH; Gastroenterology & Hepatology; RECIPIENTS; RACE; Science & Technology; KIDNEY-TRANSPLANTATION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

Racial and socioeconomic disparities exist in liver transplantation (LT) outcomes among adults, but little research exists for pediatric LT populations. We examined racial differences in graft survival and mortality within a retrospective cohort of pediatric and young adult LT recipients at a large children's transplant center in the Southeast between 1998 and 2011. The association between race/ethnicity and rates of graft failure and mortality was examined with Cox proportional hazards models that were adjusted for demographic and clinical factors as well as individual-level and census tract-level socioeconomic status (SES). Among the 208 LT recipients, 51.0% were white, 34.6% were black, and 14.4% were other race/ethnicity. Graft survival and patient survival were higher for whites versus minorities 1, 3, 5, and 10 years after transplantation. The 10-year graft survival rates were 84% [95% confidence interval (CI) = 76%-91%] for white patients, 60% (95% CI = 46%-74%) for black patients, and 49% (95% CI = 23%-77%) for other race/ethnicity patients. The 10-year patient survival rates were 92% (95% CI = 84%-96%), 65% (95% CI = 52%-79%), and 76% (95% CI = 54%-97%) for the white, black, and other race/ethnicity groups, respectively. In analyses adjusted for demographic, clinical, and socioeconomic characteristics, the rates of graft failure [black: hazard ratio (HR) = 2.59, 95% CI = 1.29-5.45; other: HR = 3.01, 95% CI = 1.23-7.35] and mortality (black: HR = 4.24, 95% CI = 1.54-11.69; other: HR = 3.09, 95% CI = 0.78-12.19) were higher for minority groups versus whites. In conclusion, at a large pediatric transplant center in the Southeastern United States, racial/ethnic disparities exist in pediatric and young adult LT outcomes that are not fully explained by measured SES and clinical factors. Liver Transpl 20:100-115, 2014.