Black patients and women have reduced access to liver transplantation for alcohol-associated liver disease.
Academic Article
Overview
abstract
BACKGROUND AND AIMS: While gender and racial disparities for liver transplantation (LT) are known, it is unclear if disparities exist for patients with alcohol-associated liver disease (ALD). We aimed to compare gender and racial/ethnic differences in mortality, LT listing, and LT rates in patients with and without ALD. METHODS: We analyzed patients who were listed for LT and/or died of end-stage liver disease (ESLD) between 2014-2018, using the UNOS and Center for Disease Control Wide-ranging OnLine Data for Epidemiologic Research (CDC WONDER) databases, respectively. Patients with ALD were compared to non-ALD patients. Our primary outcome was the ratio of listings for LT to deaths from ESLD - listing to death ratio (LDR)- a previously derived metric to assess access to the waitlist. Chi-squared and multivariable linear regression analyzed differences between gender and race/ethnicity. RESULTS: There were 65,588 deaths and 16,133 listings for ALD compared to 75,020 deaths and 40,194 listings for non-ALD. LDR was lower for ALD (0.25 vs. 0.54, p<0.001). Black patients had the lowest LDR in both ALD and non-ALD (0.13 and 0.39 for Black patients vs. 0.26 and 0.54 for White patients, p<0.001). Women with ALD had a lower LDR (0.21 vs. 0.26, p<0.001), while women without ALD had higher LDR than men (0.69 vs. 0.47, p<0.001). There were significant negative interactions between women and ALD in LDR and transplant-to-death ratio. Multivariable analysis and a sensitivity analysis, with more liberal definitions of ALD and non-ALD, confirmed these findings. CONCLUSIONS: Patients with ALD have lower access to LT. Among those with ALD, female and Black patients have the lowest access. New initiatives are needed to eliminate these inequities.
