Disparities in liver transplantation: the association between donor quality and recipient race/ethnicity and sex

Transplantation. 2014 Apr 27;97(8):862-9. doi: 10.1097/01.tp.0000438634.44461.67.


Background: We aimed to examine the association between recipient race/ethnicity and sex, donor liver quality, and liver transplant graft survival.

Methods: Adult non-status 1 liver recipients transplanted between March 1, 2002, and December 31, 2008, were identified using Scientific Registry of Transplant Recipients data. The factors of interest were recipient race/ethnicity and sex. Donor risk index (DRI) was used as a donor quality measure. Logistic regression was used to assess the association between race/ethnicity and sex in relation to the transplantation of low-quality (high DRI) or high-quality (low DRI) livers. Cox regression was used to assess the association between race/ethnicity and sex and liver graft failure risk, accounting for DRI.

Results: Hispanics were 21% more likely to receive low-quality grafts compared to whites (odds ratio [OR]=1.21, P=0.002). Women had greater odds of receiving a low-quality graft compared to men (OR=1.24, P<0.0001). Despite adjustment for donor quality, African American recipients still had higher graft failure rates compared to whites (hazard ratio [HR]=1.28, P<0.001). Hispanics (HR=0.89, P=0.023) had significantly lower graft failure rates compared to whites despite higher odds of receiving a higher DRI graft. Using an interaction model of DRI and race/ethnicity, we found that the impact of DRI on graft failure rates was significantly reduced for African Americans compared to whites (P=0.02).

Conclusions: This study shows that while liver graft quality differed significantly by recipient race/ethnicity and sex, donor selection practices do not seem to be the dominant factor responsible for worse liver transplant outcomes for minority recipients.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Asian / statistics & numerical data
  • Black or African American / statistics & numerical data
  • Cadaver
  • Ethnicity / statistics & numerical data*
  • Female
  • Graft Survival*
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Liver Transplantation / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Factors
  • Sex Distribution
  • Tissue Donors / statistics & numerical data*
  • Tissue and Organ Procurement / statistics & numerical data
  • United States / epidemiology
  • White People / statistics & numerical data