Recent articles highlight a huge gap in the availability of living donor liver transplants (LDLTs) when examined based on racial/ethnic background.
- YR Nobel et al. Liver Transpl 2015; 21: 904-13.
- A Doyle et al. Liver Transpl 2015; 21: 897-903.
What is the reason for this inequality?
The first study examined UNOS data from 2002-2014 among adult liver transplant recipients. Of 35,401 recipients, 2171 (6.1%) received a LDLT.
- Cholestatic liver disease: When compared with white patients, the odds ratios of receiving LDLT were 0.35 for African American, 0.58 for Hispanic, and 0.11 for Asian.
- Noncholestatic liver disease: When compared with white patients, the odds ratios of receiving LDLT were 0.53 for African American, 0.78 for Hispanic, and 0.45 for Asian.
- LDLT recipients were more likely to have private insurance
The second study did not look at racial/ethnic background but instead focused on other recipient factors. Using a retrospective cohort of 491 consecutive patients, they determined that all of the following resulted in a lower likelihood of LDLT:
- Single — OR 0.34
- Divorced –OR 0.53
- Immigrant — OR 0.38
- Low income quintile — OR 0.44
Together these studies allow speculation on why there is such a disparity.
- Financial costs, including lost wages, could preclude those with lower socioeconomic status from being available as donors
- Distrust of donation system and/or fear of surgery
Bottomline: Racial/ethnic differences and financial resources are associated with significant access inequality to living donor liver transplantation.
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- Zip Code or Genetic Code -which is more important … – gutsandgrowth
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- Race Associated with Outcomes in Intestinal Failure | gutsandgrowth