Race and ethnicity in access to and outcomes of liver transplantation: a critical literature review

Abstract

Racial/ethnic disparities in access to and outcomes of liver transplantation are an important topic given the increasing diversity in the United States. Most reports on this topic predate the advent of allocation based on the model for end-stage liver disease (MELD). For many patients with a variety of lethal conditions, liver transplantation is the only effective therapy, signifying the importance of equitable access to care. Racial/ethnic disparities have been described at various steps of the liver transplant process, including liver disease prevalence and treatment, access to a transplant center and its waitlist, receipt of a liver transplant and posttransplant outcomes. The purpose of this minireview is to critically evaluate the published literature on racial/ethnicity-based disparities in liver disease prevalence and treatment, transplant center referral, transplant rates and posttransplant outcomes. We identify the shortcomings of previous reports and detail the barriers to completing properly constructed analyses, particularly emphasizing deficits in requisite data and the need for improved study design. Understanding the nature of race/ethnicity-based disparities in liver transplantation is necessary to improve research initiatives, policy design and serves the broader responsibility of providing the highest quality care to all patients with liver disease.

Figure 1. A Conceptual Model of Disparities in the Liver Transplant Process

The patient with end-stage liver disease must navigate through several complex steps in order to successfully undergo liver transplantation if indicated. Several factors affect the likelihood that a patient will be able to successfully complete each step in the process. This mini-review aims to critique the available literature from each step in order to better understand racial/ethnic disparities in liver transplantation along a continuum of care.