Racial and socioeconomic disparities in pediatric and young adult liver transplant outcomes

Authors

  • Rekha V. Thammana,

    1. Emory University School of Medicine, Atlanta, GA
    2. Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
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  • Stuart J. Knechtle,

    1. Emory University School of Medicine, Atlanta, GA
    2. Department of Pediatrics, Children's Hospital of Atlanta, Atlanta, GA
    3. Center for Liver Care/Transplant, Porter Adventist Hospital, Denver, CO
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  • Rene Romero,

    1. Emory University School of Medicine, Atlanta, GA
    2. Department of Pediatrics, Children's Hospital of Atlanta, Atlanta, GA
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  • Thomas G. Heffron,

    1. Center for Liver Care/Transplant, Porter Adventist Hospital, Denver, CO
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  • Caroline T. Daniels,

    1. Department of Pediatrics, Children's Hospital of Atlanta, Atlanta, GA
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  • Rachel E. Patzer

    Corresponding author
    1. Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
    2. Emory University School of Medicine, Department of Surgery, Division of Transplantation, Atlanta, GA
    • Address reprint requests to Rachel E. Patzer, Ph.D., M.P.H., Emory University School of Medicine, Department of Surgery, Division of Transplantation, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322. Telephone: 404-727-6047; FAX: 404-727-3660; E-mail: rpatzer@emory.edu

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  • Rachel E. Patzer was supported in part by grants from the National Center for Advancing Translational Sciences of the National Institutes of Health (awards ULl TR000454 and KL2TR000455). Patzer was also supported in part by the National Institute on Minority Health and Health Disparities (1R24MD008077-01).

  • The authors of this article have no relevant conflicts of interest to report.

  • The data reported here were supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the Organ Procurement and Transplantation Network or the US Government.

  • See Editorial on Page 4

Abstract

Racial and socioeconomic disparities exist in liver transplantation (LT) outcomes among adults, but little research exists for pediatric LT populations. We examined racial differences in graft survival and mortality within a retrospective cohort of pediatric and young adult LT recipients at a large children's transplant center in the Southeast between 1998 and 2011. The association between race/ethnicity and rates of graft failure and mortality was examined with Cox proportional hazards models that were adjusted for demographic and clinical factors as well as individual-level and census tract–level socioeconomic status (SES). Among the 208 LT recipients, 51.0% were white, 34.6% were black, and 14.4% were other race/ethnicity. Graft survival and patient survival were higher for whites versus minorities 1, 3, 5, and 10 years after transplantation. The 10-year graft survival rates were 84% [95% confidence interval (CI) = 76%-91%] for white patients, 60% (95% CI = 46%-74%) for black patients, and 49% (95% CI = 23%-77%) for other race/ethnicity patients. The 10-year patient survival rates were 92% (95% CI = 84%-96%), 65% (95% CI = 52%-79%), and 76% (95% CI = 54%-97%) for the white, black, and other race/ethnicity groups, respectively. In analyses adjusted for demographic, clinical, and socioeconomic characteristics, the rates of graft failure [black: hazard ratio (HR) = 2.59, 95% CI = 1.29-5.45; other: HR = 3.01, 95% CI = 1.23-7.35] and mortality (black: HR = 4.24, 95% CI = 1.54-11.69; other: HR = 3.09, 95% CI = 0.78-12.19) were higher for minority groups versus whites. In conclusion, at a large pediatric transplant center in the Southeastern United States, racial/ethnic disparities exist in pediatric and young adult LT outcomes that are not fully explained by measured SES and clinical factors. Liver Transpl 20:100–115, 2014. © 2013 AASLD.

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