Racial disparities have been demonstrated in solid organ transplantation with regard to wait times and patient/graft survival but intestinal transplantation (IT) has not been as extensively examined. Our objective was to explore the impact of MELD/PELD on health disparities in pediatric IT.

Methods: Using the UNOS dataset, we examined wait times, wait list mortality, and patient and graft survival for Caucasian, African-American, and Hispanic children undergoing pediatric (< 18 years) IT from 1/1/1988-12/31/2014. The analysis was divided into 3 eras, Before MELD/PELD, (1/1/1993-2/26/2002), following implementation of MELD/PELD, (2/27/2002-6/19/2007), following policy revision awarding 23 extra points to patients listed for liver-intestine (6/20/2007-12/31/2014). Caucasians were the baseline reference group.

RESULTS: 1576 children were listed for pediatric IT in this cohort. The percentages of Caucasian, African-American, and Hispanic children were 65%, 19%, and 13% respectively. Of those listed, 83% Caucasians, 80% African Americans, and 79% of Hispanics were listed for liver-inclusive grafts. The most common underlying diagnosis for IT was gastroschisis (24.3%). African American patients with gastroschisis who received liver inclusive intestinal grafts had worse outcomes than other groups throughout the study: Mortality Hazard Ratio (HR) 2.0, p=0.04, (95^th% CI: 1.03-4.1). Hispanics undergoing isolated IT fared worse with a mortality HR of 3.5, p=0.003 (95% CI: 1.5-7.8). Wait list mortality was increased for Hispanic children undergoing liver inclusive IT with a HR of 2.1, p= 0.02, (95^th% CI: 1.1-3.8). Both of these latter differences resolved after the implementation of MELD/PELD. Waiting list mortality declined for all races during the most recent era p<0.001; however, wait list mortality in Hispanics was 9% vs 4% for the other groups but did not reach significance.

Conclusion: Overall, there were improvements in patient survival and waiting list mortality with regards to Hispanics after the implementation of MELD/PELD. It is unclear as to why gastroschisis requiring liver-inclusive grafts portend a worse outcome for African Americans. Further exploration into these patient populations is needed to identify the risk factors for these outcomes.

CITATION INFORMATION: Cohran V, Mohammed S, Prozialeck J, Gaddam A, Caicedo J. Health Disparities in Pediatric Intestinal Transplantation: Before and After the Implementation of MELD/PELD. Am J Transplant. 2016;16 (suppl 3).

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