*Purpose: Despite improvements in survival for all races in the past twenty years, African American patients have worse liver transplant outcomes after undergoing orthotopic liver transplantation (OLT)⁴. This paper aims at evaluating the existence and quantifying the change in disparities in survival after liver transplantation for African Americans compared to other races.

*Methods: We retrospectively analyzed deidentified patient data of all candidates who received a liver transplant between Jan 1, 2007 and Dec. 31^st 2017, using the United Network for Organ Sharing data. Four 2.5-year eras and three racial-cohorts, including African American, Caucasian, or Other (Hispanic, Asian, other races), were created.

*Results: Multivariate Cox proportional hazards regression analysis indicated similar increases in survival over time for each race with a 7% (HR= 0.930 (0.881, 0.981), p= 0.008, 12% (HR= 0.882 (0.847, 0.919), p= <0.001, and 12% (HR= 0.883 (0.851, 0.915), p= < 0.001) increase in survival for African Americans for era 2, 3, and 4 respectively when compared to era 1. There were statistically significant disparities in survival, but no obvious trend over the four eras with the risk of mortality for African Americans with hazard ratios being 8% (HR= 1.083 (1.034, 1.134, p=0.001), 9% (HR= 1.090(1.035, 1.149), p=0.001), 7% (HR=1.070 (1.008, 1.136), 0.026), and 12% (HR=1.125 (1.046, 1.209), p=0.001), respectively.

*Conclusions: While African Americans have seen substantial increases in survival in the past decade, a similar increase in survival for other races leaves a significant and consistent disparity in survival for African Americans. This study highlights the need for future research and policies aimed at moving towards the critical goal of racial equity in survival after liver transplantation.

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