Black patients have lower liver transplant survival rates than white or Hispanic patients, and researchers are concerned that the survival rate disparity between these groups has only widened over time.
On average between 2002 and 2018, Black patients had a 15% higher chance of dying after a liver transplant than white or Hispanic patients, according to a study by Keck Medicine of USC.
While researchers assumed outcomes for Black liver transplant recipients would improve in the years following a 2002 landmark study detailing the disparity, Brian Lee, a study author and liver transplant specialist with Keck Medicine, said he was surprised to find that the opposite was true.
"You'd expect [with] all the interventions and all the attempts that our community has made to address the disparity with a new organ allocation system and legislation to financially help with solid organ recipients, that disparity would have improved," Lee said. "It is eye-opening that not only does this disparity still exist, it's gotten worse."
From 2017 to 2018, Lee said Black patients actually had a 60% higher chance of dying after a liver transplant than white patients. The survival gap between Black patients and white patients also increases with the number of years post-transplant, he said.
One year post transplant, white patients had an 89% survival rate and Black patients had a 87.5% survival rate, and five years post transplant, white patients had an 72.4% survival rate and Black patients had a 65.6% survival rate, according to the Organ Procurement and Transplantation Network.
Most of the issues impacting Black patients' survival rates start prior to the liver transplant operation with a lack of access to proper care and services, said Kiran Dhanireddy, executive director of the Transplant Institute at Tampa General Hospital.
"Black patients are systematically disadvantaged in that they tend to be referred later for transplant and later for appropriate management of their advanced liver disease," Dhanireddy said. "Therefore, by the time they get listed for transplant, they have a higher acuity level.
He said having a higher severity of liver disease results in a higher rate of complication and mortality while awaiting transplant, as well as poor post-transplant outcomes, often due to acute or chronic organ rejection.
The Keck Medicine study, which used data from the United Network for Organ Sharing registry and focused on the post-transplant life expectancy of around 47,000 patients, found that factors such as alcohol-associated liver disease and patient insurance disproportionately affected Black liver-transplant recipients' survival rates.
The proportion of alcohol-associated liver disease among Black liver-transplant recipients nearly doubled from 2002 to 2018, compared to the disease's 36% increase among white liver-transplant recipients.
Liver recipients with private insurance were found to have higher survival rates than those with Medicaid, which Black patients were most likely to be insured under, Lee said.
Systematic biases and barriers also exist within transplant centers in terms of the need for social support—for family members who can take off from work—medical literacy, and a focused care approach, said Robert Brown, chief of gastroenterology and hepatology at Weill Cornell Medicine.
He said many centers, including the NewYork-Presbyterian Hospital, have created liver and kidney transplantation programs to educate the medical teams on unconscious bias and develop strategies for better treatment as well as outreach into communities of color to decrease the barriers to referral.
"We've finally gotten to a point where we're beginning to recognize the impact of racial, ethnic and socioeconomic disparities on healthcare, and I hope this recognition will lead to both further research, and more importantly, to proactive solutions," Brown said. "Until you start to do introspection, it's impossible to fix these problems."