Disparity in liver transplantation by race

July 14, 2004

Black people in the United States have reduced access to many medical therapies and liver transplantation is one area where such disparity is suspected to exist. A new study shows that black patients with chronic liver disease are indeed less likely than white patients to receive a transplant within four years and are more likely to die while awaiting a new liver.

This study is published in the July 2004 issue of Liver Transplantation — the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). Published by John Wiley & Sons, Inc., Liver Transplantation is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation, and the study is available online for free to the general public.

Previous studies have suggested that minorities experience barriers to liver transplantation although the reasons for this are unclear. Researchers, led by Andrea E. Reid of the Massachusetts General Hospital, set out to determine whether black and white patients are listed and receive transplants at equal rates and whether the clinical characteristics at the time of the transplant vary by race. They also hoped to identify which factors influence the access to and timing of transplantation after listing.

The researchers collected 1997 population data from the U.S. Census Bureau along with information from the United Network of Organ Sharing's liver transplant waiting list for all non-Hispanic black and white patients who were listed or received a transplant between 1994 and 1998. They collected information about each patient's listing date, age, gender, blood type, diagnosis, region, insurance, waiting time, and reason for removal from the list. They also determined each patient's "status," that is, the severity of their liver disease. They then performed statistical analyses on the data.

The authors compared the racial distribution of the waiting list to that of the country and found that blacks were underrepresented. At a time when 13.6 percent of the population was black, just 8.4 percent of the waiting list, and 7.9 percent of transplant recipients were too. Given that mortality data indicates a higher prevalence of end-stage liver disease among black Americans, these numbers are particularly disturbing.

Their results show that "blacks were underrepresented on orthotopic liver transplant (OLT) lists, blacks and whites on the OLT list differed significantly with regard to medical and sociodemographic characteristics, blacks were more likely than whites to die while waiting for OLT, and blacks with chronic disease were less likely to receive OLT within 4 years compared with whites," the authors report. "These findings raise important questions about the access to and timing of OLT among blacks compared with whites."

While the findings are hard to explain, they are consistent with other studies that have shown that blacks encounter barriers to sophisticated medical therapies. "Race is likely a proxy for unmeasured factors, such as lower socioeconomic status, which may influence access to and quality of medical care," the authors suggest.

Though the study was limited by its dependence on data from a large administrative database and on older information which may not reflect current listing practices and outcomes, the results "highlight the need for further research to identify the barriers to OLT faced by black patients with end-stage liver disease and to identify those factors that are amenable to change," the authors conclude.
Article: "Disparity in Use of Orthotopic Liver Transplantation Among Blacks and Whites" Andrea E. Reid, Maria Resnick, YuChiao Chang, Nathan Buerstatte, and Joel S. Weissman, Liver Transplantation; July 2004; 10:7; pp. 834-841.


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