*Purpose: Living donor liver transplantation (LDLT) is associated with improved survival and lower hospital costs, but it continues to makes up less than 5% of transplant procedures in the U.S. In this study, the Scientific Registry of Transplant Recipients (SRTR) was analyzed to determine if there are socioeconomic differences between deceased donor liver transplant (DDLT) and LDLT recipients, and if these affect access to LDLT or waitlist mortality.

*Methods: Scientific Registry of Transplant Recipients data for liver transplant candidates listed between 1/2002 and 12/2017 were included. Statistical analysis was used to compare DDLT and LDLT recipients (nonparametric analysis of variance) and assess predictors of waitlist mortality (competing risk).

*Results: Living donor liver transplantation recipients are more likely to have private insurance (57.1% vs. 73.1%, p<0.001), be Caucasian (85.6% vs. 93%, p<0.001), and have an associate degree or college degree (36.3% vs. 41.1%, p<0.001). Waiting time for LDLT was longer than DDLT. Public insurance [Medicare RR 1.20 (1.16-1.23) p<0.001, Medicaid RR 1.21 (1.17-1.25) p<0.001], Latino ethnicity (p<0.001), and lower education level (p<0.001) were associated with increased waitlist mortality on multi-variate analysis. Public insurance was associated with increased waitlist mortality even when controlling for education level, ethnicity, and race. The proportion of LDLT recipients with private insurance has declined over time, while those with Medicare has increased, and those with Medicaid has remained relatively stable despite Medicaid expansion (Figure 1).

*Conclusions: Caucasian patients with high levels of education and private insurance are more likely to undergo LDLT and less likely to suffer waitlist mortality. Public insurance is both a predictor of reduced waitlist survival and decreased likelihood of undergoing LDLT, and the proportion of patients transplanted with public insurance is increasing over time.

« Back to 2020 American Transplant Congress