Variation in Racial Disparities in Liver Transplant Outcomes Across Transplant Centers in the United States.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
28
08
2020
received:
27
05
2020
accepted:
22
09
2020
pubmed:
11
10
2020
medline:
20
5
2021
entrez:
10
10
2020
Statut:
ppublish
Résumé
Little is known about the role that transplant centers may play in perpetuating racial disparities after liver transplantation, which are unexplained by patient-level factors. We examined variation in between-center and within-center disparities among 34,114 Black and White liver transplant recipients in the United States from 2010 to 2017 using Scientific Registry of Transplant Recipient (SRTR) data. We used Cox proportional hazards models to calculate transplant center-specific Black-White hazard ratios and hierarchical survival analysis to examine potential effect modification of the race-survival association by transplant center characteristics, including transplant volume, proportion of Black patients, SRTR quality rating, and region. Models were sequentially adjusted for clinical, socioeconomic, and center characteristics. After adjustment, Black patients experienced 1.11 excess deaths after liver transplant per 100 person-years compared with White patients (95% confidence interval [CI], 0.65-1.56), corresponding to a 21% increased mortality risk (95% CI, 1.12-1.31). Although there was substantial variation in this disparity across transplant centers, there was no evidence of effect modification by transplant center volume, proportion of minority patients seen, quality rating, or region. We found significant racial disparities in survival after transplant, with substantial variation in this disparity across transplant centers that was not explained by selected center characteristics. This is the first study to directly evaluate the role transplant centers play in racial disparities in transplant outcomes. Further assessment of the qualitative factors that may drive disparities, such as selection processes and follow-up care, is needed to create effective center-level interventions to address health inequity.
Identifiants
pubmed: 33037711
doi: 10.1002/lt.25918
pmc: PMC8201428
mid: NIHMS1637847
pii: 01445473-202104000-00017
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
558-567Subventions
Organisme : NIMHD NIH HHS
ID : F31 MD014051
Pays : United States
Informations de copyright
Copyright © 2020 by the American Association for the Study of Liver Diseases.
Références
Quillin III RC, Wilson GC, Wima K, Hanseman DJ, Sutton JM, Shaw JJ, et al. Independent effect of Black recipient race on short‐term outcomes after liver transplantation. Surgery 2015;157:774–784.
Hong JC, Kosari K, Benjamin E, Duffy JP, Ghobrial RM, Farmer DG, et al. Does race influence outcomes after primary liver transplantation? A 23‐year experience with 2,700 patients. J Am Coll Surg 2008;206:1009–1016; discussion 1016‐1008.
Ananthakrishnan AN, Saeian K. Racial differences in liver transplantation outcomes in the MELD era. Am J Gastroenterol 2008;103:901–910.
Quillin III RC, Wilson GC, Wima K, Hohmann SF, Sutton JM, Shaw JJ, et al. Neighborhood level effects of socioeconomic status on liver transplant selection and recipient survival. Clin Gastroenterol Hepatol 2014;12:1934–1941.
Julapalli VR, Kramer JR, El‐Serag HB. Evaluation for liver transplantation: adherence to AASLD referral guidelines in a large Veterans Affairs center. Liver Transpl 2005;11:1370–1378.
Xu L, Kim Y, Spolverato G, Gani F, Pawlik TM. Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States. Hepatobiliary Surg Nutr 2016;5:43–52.
Axelrod DA, Guidinger MK, McCullough KP, Leichtman AB, Punch JD, Merion RM. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant 2004;4:920–927.
Ross K, Patzer RE, Goldberg DS, Lynch RJ. Sociodemographic determinants of waitlist and post‐transplant survival among end‐stage liver disease patients. Am J Transplant 2017;17:2879–2889.
Axelrod DA. Balancing accountable care with risk aversion: transplantation as a model. Am J Transplant 2013;13:7–8.
Kothari AN, Loy VM, Brownlee SA, Ezure Y, Schaidle‐Blackburn C, Cotler SJ, et al. Adverse effect of post‐discharge care fragmentation on outcomes after readmissions after liver transplantation. J Am Coll Surg 2017;225:62–67.
Wong RJ, Corley DA. Survival differences by race/ethnicity and treatment for localized hepatocellular carcinoma within the United States. Dig Dis Sci 2009;54:2031–2039.
Ananthakrishnan AN, Saeian K. Racial differences in liver transplantation outcomes in the MELD era. Am J Gastroenterol 2008;103:901–910.
Ozhathil DK, Li YF, Smith JK, Tseng JF, Saidi RF, Bozorgzadeh A, Shah SA. Impact of center volume on outcomes of increased‐risk liver transplants. Liver Transpl 2011;17:1191–1199.
Wey A, Salkowski N, Kasiske BL, Skeans M, Schaffhausen CR, Gustafson SK, et al. Comparing Scientific Registry of Transplant Recipients posttransplant program‐specific outcome ratings at listing with subsequent recipient outcomes after transplant. Am J Transplant 2019;19:391–398.
Schold JD, Buccini LD. Five‐tier futility: this should end any remaining debate. Am J Transplant 2019;19:607.
Schold JD, Andreoni KA, Chandraker AK, Gaston RS, Locke JE, Mathur AK, et al. Expanding clarity or confusion? Volatility of the 5‐tier ratings assessing quality of transplant centers in the United States. Am J Transplant 2018;18:1494–1501.
Harper S, King NB, Meersman SC, Reichman ME, Breen N, Lynch J. Implicit value judgments in the measurement of health inequalities. Milbank Q 2010;88:4–29.