Social Determinants of Health and Liver Transplant Outcomes in U.S. Indigenous Populations

Bima J Hasjim; Meera Patel; Shiyi Chen; Hirohito Ichii; Mamatha Bhat

doi:10.14309/ajg.0000000000003770

Social Determinants of Health and Liver Transplant Outcomes in U.S. Indigenous Populations

Am J Gastroenterol. 2025 Dec 1;120(12):2957-2963. doi: 10.14309/ajg.0000000000003770. Epub 2025 Sep 26.

Authors

Bima J Hasjim^{1

2}, Meera Patel², Shiyi Chen^{2

3

4}, Hirohito Ichii¹, Mamatha Bhat^{2

5

6}

Affiliations

¹ Department of Surgery, Division of Transplantation, University of California, Irvine, Orange, California, USA.
² Transplant AI initiative, Ajmera Transplant Centre, University Health Network, University of Toronto, Ontario, Canada.
³ Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
⁴ Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
⁶ Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada .

PMID: 41002198
DOI: 10.14309/ajg.0000000000003770

Abstract

Introduction: Indigenous populations in the United States (IPUS) have disproportionately high burden of end-stage liver disease but are relatively understudied.

Methods: This retrospective study merged the Scientific Registry of Transplant Recipients Data set (2004-2024) with U.S. census data to estimate the exposure to social determinants of health (SDOH).

Results: Of 164,294 patients, 0.9% identified as IPUS and resided in areas with more vulnerable SDOH ( P < 0.001). They were less likely to receive liver transplantation (LT) compared with non-IPUS patients (subdistribution hazard ratio 0.92; 95% confidence interval 0.85-0.99), but had similar risks of waitlist mortality, post-LT mortality, and graft failure.

Discussion: IPUS face SDOH challenges and lower rates of LT after waitlisting but can still achieve post-LT outcomes similar to non-IPUS patients.

Keywords: graft failure; indigenous populations; liver transplant; social determinants of health; waitlist; waitlist mortality.

MeSH terms

Adult
Aged
End Stage Liver Disease* / ethnology
End Stage Liver Disease* / mortality
End Stage Liver Disease* / surgery
Female
Humans
Liver Transplantation* / statistics & numerical data
Male
Middle Aged
Registries
Retrospective Studies
Social Determinants of Health* / statistics & numerical data
United States / epidemiology
Waiting Lists / mortality