OBJECTIVE: African Americans and other minorities are known to face barriers to health care influencing their access to organ transplantation but it is not known whether these barriers exist among pediatric liver transplant waitlist candidates. We sought to determine whether outcomes on the waitlist (ie, mortality, deceased donor liver transplantation [DDLT], and living-donor liver transplantation [LDLT]) varied by race/ethnicity. METHODS: National registry data were studied to estimate the race/ethnicity-specific risk of waitlist mortality, DDLT and LDLT in children (<18 years) waitlisted between March 2002 and March 2015. RESULTS: There was no evidence of racial/ethnic disparities in waitlist mortality. Compared to Caucasians, LDLT varied by race/ethnicity, with only 6.7% African Americans and 10.3% Hispanic children receiving LDLT compared with 12.4% Caucasian, 13.3% Asian, and 9.4% mix/other children. In an adjusted Cox proportional hazards model, African Americans were half as likely as Caucasians to use LDLT (hazard ratio [HR]: 0.410.550.73) but had similar use of DDLT (HR: 0.981.061.16). In a model that considered mortality, DDLT, and LDLT as competing risks, African Americans had significantly reduced incidence of LDLT (subhazard ratio [sHR]: 0.410.560.75) compared to Caucasians, but increased use of DDLT (sHR: 1.061.161.26). CONCLUSIONS: Compared to Caucasian children, African-American children are less likely to use LDLT but have higher rates of DDLT and similar survival on the waitlist. Additional research is necessary to understand the clinical and socioeconomic factors contributing to lower utilization of LDLT among African-American children awaiting transplantation.
OBJECTIVE: African Americans and other minorities are known to face barriers to health care influencing their access to organ transplantation but it is not known whether these barriers exist among pediatric liver transplant waitlist candidates. We sought to determine whether outcomes on the waitlist (ie, mortality, deceased donor liver transplantation [DDLT], and living-donor liver transplantation [LDLT]) varied by race/ethnicity. METHODS: National registry data were studied to estimate the race/ethnicity-specific risk of waitlist mortality, DDLT and LDLT in children (<18 years) waitlisted between March 2002 and March 2015. RESULTS: There was no evidence of racial/ethnic disparities in waitlist mortality. Compared to Caucasians, LDLT varied by race/ethnicity, with only 6.7% African Americans and 10.3% Hispanic children receiving LDLT compared with 12.4% Caucasian, 13.3% Asian, and 9.4% mix/other children. In an adjusted Cox proportional hazards model, African Americans were half as likely as Caucasians to use LDLT (hazard ratio [HR]: 0.410.550.73) but had similar use of DDLT (HR: 0.981.061.16). In a model that considered mortality, DDLT, and LDLT as competing risks, African Americans had significantly reduced incidence of LDLT (subhazard ratio [sHR]: 0.410.560.75) compared to Caucasians, but increased use of DDLT (sHR: 1.061.161.26). CONCLUSIONS: Compared to Caucasian children, African-American children are less likely to use LDLT but have higher rates of DDLT and similar survival on the waitlist. Additional research is necessary to understand the clinical and socioeconomic factors contributing to lower utilization of LDLT among African-American children awaiting transplantation.
Authors: W R Kim; J R Lake; J M Smith; M A Skeans; D P Schladt; E B Edwards; A M Harper; J L Wainright; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2015-01 Impact factor: 8.086
Authors: Benjamin L Shneider; Morton B Brown; Barbara Haber; Peter F Whitington; Kathleen Schwarz; Robert Squires; Jorge Bezerra; Ross Shepherd; Philip Rosenthal; Jay H Hoofnagle; Ronald J Sokol Journal: J Pediatr Date: 2006-04 Impact factor: 4.406
Authors: Yael R Nobel; Kimberly A Forde; Linda Wood; Katarzyna Cartiera; Armando S Munoz-Abraham; Peter S Yoo; Peter L Abt; David S Goldberg Journal: Liver Transpl Date: 2015-06-09 Impact factor: 5.799
Authors: Douglas G Farmer; Robert S Venick; Sue V McDiarmid; Rafik M Ghobrial; Sherilyn A Gordon; Hasan Yersiz; Johnny Hong; Leah Candell; Argine Cholakians; Laura Wozniak; Martin Martin; Jorge Vargas; Marvin Ament; Jonathan Hiatt; Ronald W Busuttil Journal: J Am Coll Surg Date: 2007-05 Impact factor: 6.113
Authors: Paula Buchanan; Nino Dzebisashvili; Krista L Lentine; David A Axelrod; Mark A Schnitzler; Paolo R Salvalaggio Journal: Liver Transpl Date: 2009-10 Impact factor: 5.799
Authors: Sharad I Wadhwani; Jin Ge; Laura Gottlieb; Courtney Lyles; Andrew F Beck; John Bucuvalas; John Neuhaus; Uma Kotagal; Jennifer C Lai Journal: Hepatology Date: 2021-12-08 Impact factor: 17.425
Authors: Douglas B Mogul; Joy Lee; Tanjala S Purnell; Allan B Massie; Tanveen Ishaque; Dorry L Segev; John F P Bridges Journal: Pediatr Transplant Date: 2019-06-19