Ayuk-Arrey Arrey-Takor, Nephew Lauren, Caicedo Juan Carlos, Ross-Driscoll Katherine
Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Liver Transpl. 2025 Jul 1;31(7):857-869. doi: 10.1097/LVT.0000000000000561. Epub 2025 Jan 14.
Prior studies have demonstrated racial disparities in access to liver transplantation, but the determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients and the National Center for Health Statistics from 2015 to 2021. The primary outcome was the difference in the listing-to-end-stage liver disease death ratio between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, health care access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower listing-to-end-stage liver disease death ratios than White patients in 80% of TRRs, while Hispanic patients had equal or higher listing-to-end-stage liver disease death ratios compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.
先前的研究已经证明在肝移植可及性方面存在种族差异，但这些差异的决定因素仍知之甚少。我们使用移植中心的地理服务区域（移植转诊区域，TRRs）来描述导致肝移植可及性方面种族和民族差异的移植环境因素。数据来自2015年至2021年的移植受者科学登记处和国家卫生统计中心。主要结局是每个TRR中黑人、西班牙裔和非西班牙裔白人患者从列入名单到终末期肝病死亡比例的差异。我们使用多变量线性回归分析了人口统计学、社会经济地位、医疗服务可及性、器官可用性和移植中心竞争等因素。我们使用Levene方差检验检查了等待名单构成在TRR内的差异。在纳入的66个TRR中，80%的TRR中黑人患者从列入名单到终末期肝病死亡的比例低于白人患者，而在56%的TRR中，西班牙裔患者从列入名单到终末期肝病死亡的比例与白人患者相当或更高。多变量模型无法解释TRR之间种族差异的大部分变化。排除与肝癌相关死亡的患者后，差异有所减弱。在包含多个移植中心的27个TRR中，黑人与西班牙裔等待名单构成在TRR之间的差异具有统计学意义。我们观察到美国各地肝移植可及性方面种族差异程度存在很大的地理差异。研究结果凸显了在差异较大地区进行有针对性的健康公平干预的必要性，以及为移植中心制定对差异敏感的可及性指标的必要性。
