Disparities in liver transplantation

The association between donor quality and recipient Race/Ethnicity and sex

Amit Mathur, Douglas E. Schaubel, Hui Zhang, Mary K. Guidinger, Robert M. Merion

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)862-869
Number of pages8
JournalTransplantation
Volume97
Issue number8
DOIs
StatePublished - Apr 27 2014
Externally publishedYes

Fingerprint

Liver Transplantation
Tissue Donors
Transplants
Liver
Hispanic Americans
African Americans
Sex Preselection
Odds Ratio
Donor Selection
Liver Failure
Graft Survival
Registries
Transplantation
Logistic Models

Keywords

  • Clinical outcomes
  • Donor risk
  • Liver graft survival
  • Liver transplantation
  • Racial and ethnic disparities

ASJC Scopus subject areas

  • Transplantation

Cite this

Disparities in liver transplantation : The association between donor quality and recipient Race/Ethnicity and sex. / Mathur, Amit; Schaubel, Douglas E.; Zhang, Hui; Guidinger, Mary K.; Merion, Robert M.

In: Transplantation, Vol. 97, No. 8, 27.04.2014, p. 862-869.

Research output: Contribution to journalArticle

Mathur, Amit ; Schaubel, Douglas E. ; Zhang, Hui ; Guidinger, Mary K. ; Merion, Robert M. / Disparities in liver transplantation : The association between donor quality and recipient Race/Ethnicity and sex. In: Transplantation. 2014 ; Vol. 97, No. 8. pp. 862-869.
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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.

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KW - Racial and ethnic disparities

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