INTRODUCTION: Differences in access to OLTx continue to be present in minorities. Pediatric pts represent a particularly vulnerable population within minorities groups in need for OLTx. Cultural and language barriers are contributing factors which increase ethnic disparities not only pre but also post-transplant, affecting pt and graft survival. Overcoming language barrier may help to improve not only access to transplantation but also outcomes in pediatric OLTx recipients.

MAT,ERIAL AND METHOD: Retrospective review of prospectively collected data of our experience in pediatric OLTx.

RESULTS: From 1999-2009 209 pediatric pts received 231 OLTx. Of these 18 were Hispanic and received 22 OLTx. Between 1999 and 05/2004, 4 Hispanic pediatric recipients received 7 OLTx. In this group 1-3-5 year pt survival was 100%, 75% and 37.5% while graft survival was 87.5%, 57.1%, 34.3% respectively. Based on these results, and with compliance issues affecting outcomes, a dedicated bilingual (English / Hispanic) office-data manager, who focused on parents'-patients' compliance/follow/up, was hired as part of the transplant team, in 06/2004. From 06/2004 until 09/2009 14 Hispanic pediatric recipients received 15 liver allograft with 1-3-5 years patient survival of 100% and graft survival of 93% (p=0.03, Fisher Exact Test) respectively, suggesting that language barrier was one of the main factors involved in previous lower outcomes.

CONCLUSIONS: While patient-graft survival in pediatric Hispanic OLTx pts was initially inferior to the other ethnic groups, understanding and overcoming cultural / language barriers in the fastest growing minority in the US, has helped to improve outcomes in these pts. Our data suggests that a specialized transplant knowledge may be not a determinant factor to overcome language barriers.

The improvement of overall outcomes for pediatric Hispanic pts seemed to be also associated with a better access to transplantation (reflected by the increased number of OLTx after 06/2004). A bilingual dedicated person has played a major role in achieving these results and the process has the potential for helping other ethnicities /minorities understanding individual cultural diversities and their relationship with complex post liver transplant care.

Study limitations: retrospective review, small sample size, not capturing multifactorial ethnical aspects of pediatric OLTx in the US . Larger studies may provide further data to help understanding the complex ethnical dynamics in pediatric OLTx recipients.

« Back to 2015 American Transplant Congress