INTERACTIONS BETWEEN RACE/ETHNICITY AND GENDER IN LIVER TRANSPLANTS: DO ACUITY CIRCLES MATTER?

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Hepatology

Abstract

Background: Despite continued efforts, there are welldocumented disparities in liver transplantation (LT) from listing through post-transplant. National policies on allocation of deceased donor liver transplants (DDLT) aim to provide consistent and equitable access. However, the impacts of Acuity Circles (AC) and interactions between race and gender on delisting due to deterioration/death or receipt of DDLT have been minimally explored. Methods: Using data from the United Network for Organ Sharing (UNOS), we studied listed adults for DDLT from April 3, 2017, to October 4, 2022, a 60-month period (30 mo pre- and post-AC). Fine-Gray subdistribution hazard model was used to study AC impact on LT while delisting due to deterioration/ death was used as a competing risk. The model focused on AC indicator by race by gender interactions, as well as AC by hepatocellular carcinoma (HCC) diagnosis interactions. Results: 59,592 patients (30,202 pre-AC, 29,390 post-AC) were studied. No 3- way (AC X race X gender) interaction was detected, indicating effect of race and gender on LT was consistent pre- and post-AC periods. However, there were significant gender by race or AC by HCC interactions (Table 1): patients with HCC had greater chance for LT than non-HCC, though post-AC this effect was reduced. AC increased LT 25% in patients without HCC. Across gender, White, Black, and Hispanic men were more likely to receive transplant compared to their female counterparts. Within gender, Black and Hispanic women were less likely to receive transplant than White women, with no significant differences between White and Asian women. For men, there were no statistical difference in likelihood for transplant between White versus Black or Hispanic men, but Asian men had a lower likelihood for LT than White men. Additional significant predictors outlined in Table 1. Conclusion: Accounting for listing characteristics, AC did not significantly impact interactions between gender and race on receipt of LT. However, AC may have improved access to LT amongst those without HCC but may have diminished access amongst those with HCC post-AC. Regardless of AC, there were important gender-race interactions requiring closer examination, particularly where Black and Hispanic women appear disproportionately negatively impacted. The same patterns were not noted across male racial categories, suggesting future research and interventions should target those at greatest risk. (Table Presented).

Volume

78

First Page

S277

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