Racial and regional disparity in liver transplant allocation

Background: Sources of liver transplant disparities are not understood adequately, particularly in terms of race and region.

Methods: Fixed effects multivariate logistic regression augmented by modified forward and backward stepwise regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) was performed to assess causal inference of such disparities.

Results: In the study sample (N = 258,602), significant disparities in the odds of receiving a liver were found: African Americans odds ratio 1.12 (95% confidence interval, 1.08-1.17), Asians 1.12 (95% confidence interval, 1.07-1.18), females 0.80 (95% confidence interval, 0.78-0.83), and malignancy 1.18 (95% confidence interval, 1.13-1.22). Region 7 (IL, MN, ND, SD, and WI) was set as the reference level since its transplantation rate most closely approximated the sex and race-matched rate of the national post-Share 35 average. Significant racial disparities by region were identified using Caucasian Region 7 as the reference: Hispanic Region 9 (New York, West Vermont) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Oklahoma, TX) 1.23 (1.05-1.43), and Asian Region 4 (Oklahoma, TX) 1.35 (1.05-1.73).

Conclusion: Despite numerous adjustments to liver allocation, we identified with causal inference statistics on a large dataset spanning ≥30 years there remain racial and regional overweighting.