TY - JOUR
T1 - Ethnic disparities in waitlist outcomes of patients with nonalcoholic steatohepatitis listed for liver transplantation in the US
AU - Lim, Wen Hui
AU - Yong, Jie Ning
AU - Ong, Christen En Ya
AU - Ng, Cheng Han
AU - Tan, Darren Jun Hao
AU - Zeng, Rebecca Wenling
AU - Chung, Charlotte Hui
AU - Kaewdech, Apichat
AU - Chee, Douglas
AU - Tseng, Michael
AU - Wijarnpreecha, Karn
AU - Syn, Nicholas
AU - Bonney, Glenn K.
AU - Kow, Alfred
AU - Huang, Daniel Q.
AU - Noureddin, Mazen
AU - Muthiah, Mark
AU - Tan, Eunice
AU - Siddiqui, Mohammad Shadab
N1 - Publisher Copyright:
Copyright © 2023 American Association for the Study of Liver Diseases.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - NASH is the fastest-growing cause of liver cirrhosis and is the leading indication for liver transplantation (LT). However, significant racial and ethnic disparities in waitlist outcomes and LT allocation may unfairly disadvantage minorities. Our aim was to characterize racial and ethnic disparities in waitlist mortality and transplantation probability among patients with NASH. This is a retrospective analysis of the United Network for Organ Sharing registry data of LT candidates from January 1, 2000 to December 31, 2021. Outcomes analysis was performed using competing risk analysis with the Fine and Gray model. The multivariable adjustment was conducted, and mixed-effect regression was used to compare the model for end-stage liver disease scores at listing and removal. Of 18, 562 patients with NASH cirrhosis, there were 14, 834 non-Hispanic Whites, 349 African Americans, 2798 Hispanics, 312 Asians, and 269 of other races/ethnicities; African American (effect size: 2.307, 95% CI: 1.561-3.053, and p < 0.001) and Hispanic (effect size: 0.332, 95% CI: 0.028-0.637, p = 0.032) patients were found to have a significantly higher model for end-stage liver disease scores at the time of listing than non-Hispanic Whites. African Americans had a higher probability of receiving LT relative to non-Hispanic Whites (subdistribution HR: 1.211, 95% CI: 1.051-1.396, and p = 0.008). However, Hispanic race/ethnicity was associated with a lower transplantation probability (subdistribution HR: 0.793, 95% CI: 0.747-0.842, and p < 0.001) and increased waitlist mortality (subdistribution HR: 1.173, CI: 1.052-1.308, and p = 0.004) compared with non-Hispanic Whites. There are significant racial and ethnic disparities in waitlist outcomes of patients with NASH in the US. Hispanic patients are less likely to receive LT and more likely to die while on the waitlist compared with non-Hispanic Whites despite being listed with a lower model for end-stage liver disease scores.
AB - NASH is the fastest-growing cause of liver cirrhosis and is the leading indication for liver transplantation (LT). However, significant racial and ethnic disparities in waitlist outcomes and LT allocation may unfairly disadvantage minorities. Our aim was to characterize racial and ethnic disparities in waitlist mortality and transplantation probability among patients with NASH. This is a retrospective analysis of the United Network for Organ Sharing registry data of LT candidates from January 1, 2000 to December 31, 2021. Outcomes analysis was performed using competing risk analysis with the Fine and Gray model. The multivariable adjustment was conducted, and mixed-effect regression was used to compare the model for end-stage liver disease scores at listing and removal. Of 18, 562 patients with NASH cirrhosis, there were 14, 834 non-Hispanic Whites, 349 African Americans, 2798 Hispanics, 312 Asians, and 269 of other races/ethnicities; African American (effect size: 2.307, 95% CI: 1.561-3.053, and p < 0.001) and Hispanic (effect size: 0.332, 95% CI: 0.028-0.637, p = 0.032) patients were found to have a significantly higher model for end-stage liver disease scores at the time of listing than non-Hispanic Whites. African Americans had a higher probability of receiving LT relative to non-Hispanic Whites (subdistribution HR: 1.211, 95% CI: 1.051-1.396, and p = 0.008). However, Hispanic race/ethnicity was associated with a lower transplantation probability (subdistribution HR: 0.793, 95% CI: 0.747-0.842, and p < 0.001) and increased waitlist mortality (subdistribution HR: 1.173, CI: 1.052-1.308, and p = 0.004) compared with non-Hispanic Whites. There are significant racial and ethnic disparities in waitlist outcomes of patients with NASH in the US. Hispanic patients are less likely to receive LT and more likely to die while on the waitlist compared with non-Hispanic Whites despite being listed with a lower model for end-stage liver disease scores.
KW - End Stage Liver Disease/surgery
KW - Humans
KW - Liver Cirrhosis
KW - Liver Transplantation/adverse effects
KW - Non-alcoholic Fatty Liver Disease/surgery
KW - Retrospective Studies
KW - Severity of Illness Index
KW - United States/epidemiology
KW - Waiting Lists
UR - http://www.scopus.com/inward/record.url?scp=85163942101&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85163942101&partnerID=8YFLogxK
U2 - 10.1097/LVT.0000000000000148
DO - 10.1097/LVT.0000000000000148
M3 - Article
C2 - 37039547
AN - SCOPUS:85163942101
SN - 1527-6465
VL - 29
SP - 1181
EP - 1191
JO - Liver Transplantation
JF - Liver Transplantation
IS - 11
ER -