TY - JOUR
T1 - Disparities in liver transplantation
T2 - The association between donor quality and recipient Race/Ethnicity and sex
AU - Mathur, Amit K.
AU - Schaubel, Douglas E.
AU - Zhang, Hui
AU - Guidinger, Mary K.
AU - Merion, Robert M.
PY - 2014/4/27
Y1 - 2014/4/27
N2 - BACKGROUND: We aimed to examine the association between recipient race/ethnicity and sex, donor liver quality, and liver transplant graft survival. METHODS: Adult non-status 1 liver recipients transplanted between March 1, 2002, and December 31, 2008, were identified using Scientific Registry of Transplant Recipients data. The factors of interest were recipient race/ethnicity and sex. Donor risk index (DRI) was used as a donor quality measure. Logistic regression was used to assess the association between race/ethnicity and sex in relation to the transplantation of low-quality (high DRI) or high-quality (low DRI) livers. Cox regression was used to assess the association between race/ethnicity and sex and liver graft failure risk, accounting for DRI. RESULTS: Hispanics were 21% more likely to receive low-quality grafts compared to whites (odds ratio [OR]=1.21, P=0.002). Women had greater odds of receiving a low-quality graft compared to men (OR=1.24, P<0.0001). Despite adjustment for donor quality, African American recipients still had higher graft failure rates compared to whites (hazard ratio [HR]=1.28, P<0.001). Hispanics (HR=0.89, P=0.023) had significantly lower graft failure rates compared to whites despite higher odds of receiving a higher DRI graft. Using an interaction model of DRI and race/ethnicity, we found that the impact of DRI on graft failure rates was significantly reduced for African Americans compared to whites (P=0.02). CONCLUSIONS: This study shows that while liver graft quality differed significantly by recipient race/ethnicity and sex, donor selection practices do not seem to be the dominant factor responsible for worse liver transplant outcomes for minority recipients.
AB - BACKGROUND: We aimed to examine the association between recipient race/ethnicity and sex, donor liver quality, and liver transplant graft survival. METHODS: Adult non-status 1 liver recipients transplanted between March 1, 2002, and December 31, 2008, were identified using Scientific Registry of Transplant Recipients data. The factors of interest were recipient race/ethnicity and sex. Donor risk index (DRI) was used as a donor quality measure. Logistic regression was used to assess the association between race/ethnicity and sex in relation to the transplantation of low-quality (high DRI) or high-quality (low DRI) livers. Cox regression was used to assess the association between race/ethnicity and sex and liver graft failure risk, accounting for DRI. RESULTS: Hispanics were 21% more likely to receive low-quality grafts compared to whites (odds ratio [OR]=1.21, P=0.002). Women had greater odds of receiving a low-quality graft compared to men (OR=1.24, P<0.0001). Despite adjustment for donor quality, African American recipients still had higher graft failure rates compared to whites (hazard ratio [HR]=1.28, P<0.001). Hispanics (HR=0.89, P=0.023) had significantly lower graft failure rates compared to whites despite higher odds of receiving a higher DRI graft. Using an interaction model of DRI and race/ethnicity, we found that the impact of DRI on graft failure rates was significantly reduced for African Americans compared to whites (P=0.02). CONCLUSIONS: This study shows that while liver graft quality differed significantly by recipient race/ethnicity and sex, donor selection practices do not seem to be the dominant factor responsible for worse liver transplant outcomes for minority recipients.
KW - Clinical outcomes
KW - Donor risk
KW - Liver graft survival
KW - Liver transplantation
KW - Racial and ethnic disparities
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U2 - 10.1097/01.tp.0000438634.44461.67
DO - 10.1097/01.tp.0000438634.44461.67
M3 - Article
C2 - 24345895
AN - SCOPUS:84899475435
SN - 0041-1337
VL - 97
SP - 862
EP - 869
JO - Transplantation
JF - Transplantation
IS - 8
ER -