Liver transplant waitlist removal, transplantation rates and post-transplant survival in Hispanics

Abstract

Background and objectives: Hispanics are the fastest growing population in the USA, and our objective was to determine their waitlist mortality rates, liver transplantation (LT) rates and post-LT outcomes.

Methods: All adults listed for LT with the UNOS from 2002 to 2018 were included. Competing risk analysis was performed to assess the association between ethnic group with waitlist removal due to death/deterioration and transplantation. For sensitivity analysis, Hispanics were matched 1:1 to Non-Hispanics using propensity scores, and outcomes of interest were compared in matched cohort.

Results: During this period, total of 154,818 patients who listed for liver transplant were involved in this study, of them 23,223 (15%) were Hispanics, 109,653 (71%) were Whites, 13,020 (8%) were Blacks, 6,980 (5%) were Asians and 1,942 (1%) were others. After adjusting for differences in clinical characteristics, compared to Whites, Hispanics had higher waitlist removal due to death or deterioration (adjusted cause-specific Hazard Ratio: 1.034, p = 0.01) and lower transplantation rates (adjusted cause-specific Hazard Ratio: 0.90, p<0.001). If Hispanics received liver transplant, they had better patient and graft survival than Non-Hispanics (p<0.001). Compared to Whites, adjusted hazard ratio for Hispanics were 0.88 (95% CI 0.84, 0.92, p<0.001) for patient survival and 0.90 (95% CI 0.86, 0.94, p<0.001) for graft survival. Our analysis in matched cohort showed the consistent results.

Conclusions: This study showed that Hispanics had higher probability to be removed from the waitlist due to death, and lower probability to be transplanted, however they had better post-LT outcomes when compared to whites.

Fig 1

A. Cumulative incidence of removal due to death or deterioration and liver transplantation stratified by race; B. Cumulative incidence of removal due to death or deterioration and liver transplantation in Hispanics when compared to other races (combined).

Fig 2

A. Post liver transplantation Kaplan Meier patient survival stratified by races (number at risk at different time points shown in inner panel); B. Post liver transplantation Kaplan Meier graft survival stratified by races (number at risk at different time points shown in inner panel); C. Post liver transplantation Kaplan Meier patient and graft survival in Hispanics when compared to others.

Fig 3. A: Cumulative incidence of removal due to death or deterioration and liver transplant by Hispanic (1:1 matched cohorts); B: Kaplan Meier patient and graft post-transplant survival by Hispanics and others (1:1 matched cohorts).

The groups were matched for region, age, sex, BMI, MELD score, highest education, insurance and employment.