Unveiling the Veil: Racial Disparities and Liver Transplantation Barriers Experience from the United States Southwestern Region Center

Abstract

Background: Liver transplantation (LT) is a life-saving treatment for end-stage liver disease, yet disparities in access and outcomes persist, particularly among racial and ethnic minorities. This study aims to investigate barriers encountered by LT candidates at different stages and to assess racial disparities in referral, evaluation, listing, and post-transplant outcomes.Methods: A retrospective cohort study was conducted from January 1, 2012, to December 31, 2022, at Banner University Medical Center-Phoenix. Adult LT-referred patients were analyzed for demographic and clinical variables, including race, body mass index (BMI), primary disease, Model for End-Stage Liver Disease (MELD) score, and post-transplant outcomes. Barriers were categorized into social, financial, and clinical factors. Statistical analyses included comparative tests, competing-risk regression, and multivariable Cox proportional hazards analysis. Results: Among 2,877 referrals, Native Americans accounted for 8.8%, with disparities observed in evaluation (39%) and listing (53%) compared to non-Hispanic whites (51% and 64%, respectively). Financial issues were prominent barriers for Native Americans (15.5%) and Hispanics (19.81%). Waitlist mortality was significantly higher for Native Americans (SHR: 5.26, p=0.005) and Hispanics (SHR: 2.92, p=0.017) compared to non-Hispanic whites. Graft survival did not significantly differ by race. Conclusion: This study underscores persistent racial disparities and barriers in LT access and outcomes, particularly among Native American and Hispanic populations. Financial issues and waitlist mortality disproportionately affect minority groups. Efforts to address these disparities should focus on improving access to evaluation and addressing social determinants of health. Further research is needed to explore underlying factors contributing to these disparities and to implement targeted interventions to ensure equitable access to LT for all patients.