In a new research paper, published in the American Journal of Transplantation, researchers say that the results persist even after statistically adjusted the results for a number of demographic and health factors, including patient’s residence, insurance type, diabetes status, and severity of liver disease.
When Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine, and his colleagues examined data from the last two decades of all liver transplant recipients in the United States, they discovered that during the entire study period of 2002-2018, Black patients had a 15% greater chance of dying following a liver transplant than white or Hispanic patients. And between 2017 and 2018, they had a 60% greater chance of dying following a liver transplant than white recipients.
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The survival disparity between black and white patients widened as the number of years post-transplant increased.
Despite the fact that the researchers statistically adjusted the results for a variety of demographic and health factors, including where a patient lived, their insurance type, whether they had diabetes, and the severity of their liver disease, the findings remained unchanged.
Aside from that, the researchers discovered that Black transplant recipients had a higher severity of liver disease at the time of their transplant and tended to die more frequently from acute or chronic organ rejection than white patients.
“We were very surprised by these results because almost 20 years ago, a landmark study showed that Black patients who underwent liver transplants had lower post-transplant survival rates than white and Hispanic patients, and since then, the field has made numerous interventions to try to narrow the gap,” said Lee.
“It is eye-opening that not only does this disparity still exist, it’s gotten worse.”
When researchers compared the findings of the new study with those of a landmark study conducted 20 years ago, they discovered that the survival gap initially narrowed between 2002 and 2009, remained unchanged between 2010 and 2013, and then worsened between 2013 and 2018.
When looking for explanations for the study’s findings, researchers discovered two minor — but significant — factors that contributed to the disparity in outcomes between Black and white patients.
The first was alcohol-associated liver disease, which is defined as liver damage caused by excessive alcohol consumption prior to the transplantation.
“The proportion of alcohol-associated liver disease among Black liver-transplant recipients almost doubled from 2002-2005 to 2014-2018, outpacing a 36% relative increase in the disease among white liver-transplant recipients,” Lee said.
A further finding was that the survival rate of black liver transplant recipients with alcohol-associated liver disease was lower compared to the survival rate of white liver transplant recipients with alcohol-associated liver disease.
The type of insurance that the patient had was the second most important factor. When comparing black and white patients, it was found that black patients were more likely to be covered by Medicaid rather than private insurance. The survival rates of liver transplant recipients with private insurance were higher than those with Medicaid.
For this study, researchers collected data from the United Network for Organ Sharing registry, which tracks all organ transplants in the US. They examined the post-transplant life expectancy of approximately 47,000 Black, Hispanic and white liver transplant recipients between 2002 and 2018, the last year for which adequate survival data is available. Black patients were identified as non-Hispanic Black and white transplant recipients as non-Hispanic white.
Lee hopes that the study will spur more research into how issues like alcohol use and social determinants of health affect organ transplant outcomes.
“Our findings are a huge wake-up call that physicians and other health care professionals need to do better in delivering equitable care,” said Lee.
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“Hopefully we can begin to invest in interventions that acknowledge previously undiscovered causes of inequity that will successfully narrow the disparity gap in liver transplant survival rates.”