The Confluence of Race, Socioeconomic Deprivation, and Waitlist Mortality for Children Awaiting Liver Transplant

S. Wadhwani¹, J. Ge¹, L. Gottlieb¹, C. Lyles¹, A. F. Beck², J. Bucuvalas³, U. Kotagal², J. C. Lai¹

¹University of California San Francisco, San Francisco, CA, ²Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ³Icahn School of Medicine at Mount Sinai, New York, NY

Meeting: 2021 American Transplant Congress

Abstract number: 291

Keywords: African-American, Liver transplantation, Survival, Waiting lists

Topic: Clinical Science » Liver » Liver: Pediatrics

Session Information

Session Name: Liver Pediatrics

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 7, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:10pm-6:15pm

Location: Virtual

*Purpose: Social determinants like racism, ethnocentrism, and neighborhood socioeconomic deprivation are associated with poor outcomes for children after liver transplant. We studied the relationship between race, ethnicity, and waitlist mortality, and whether this relationship is mediated by neighborhood deprivation.

*Methods: We used SRTR data for children<18 yr listed for liver transplant 2005-2015 (N=8536). Primary exposures were race, ethnicity, and a neighborhood socioeconomic deprivation index (NDI) linked to home ZIP codes (range [0,1]; higher values indicate increased deprivation). Primary outcome was waitlist mortality, defined as death or delisting for ‘being too sick'. We used competing risk analyses to associate race, ethnicity, NDI, and death with transplant as the competing risk.

*Results: There were N=7716 children-17% identified as Black and 24% as Hispanic. Median NDI was 0.38 (IQR 0.30, 0.46). Compared to White children, Black and Hispanic children had higher NDIs. In univariate analysis, Black and Hispanic children had increased hazard of waitlist mortality (sHR: 1.23; 95%CI: 1.01, 1.49 and sHR: 1.28; 95%CI: 1.08, 1.51, respectively). Each 0.1 increase in the NDI was associated with increased hazard of waitlist mortality (sHR: 1.08, 95%CI: 1.01, 1.15).

In bivariate analysis combining race and NDI, each 0.1 increase in NDI was associated with increased hazard of waitlist mortality (sHR: 1.08, 95%CI: 1.02, 1.40), however, Black race was no longer significant (sHR: 1.17 95%CI: 0.96, 1.43). In multivariable analysis combining race, NDI, and initial lab PELD/MELD, race and NDI were no longer significant.

In bivariate analysis combining ethnicity and NDI, Hispanicity was associated with increased hazard of waitlist mortality (sHR: 1.22; 95%CI: 1.02, 1.46), however, NDI was no longer significant. In multivariable analysis combining ethnicity, NDI, and initial lab PELD/MELD, Hispanicity remained associated with increased hazard of waitlist mortality (sHR: 1.20; 95%CI: 1.00, 1.43).

*Conclusions: Black race is associated with increased waitlist mortality. This risk may be mediated by neighborhood deprivation; which, in turn, may be mediated by disease severity. Hispanic ethnicity conferred increased risk of waitlist mortality after adjusting for deprivation and initial lab PELD/MELD—suggesting that other social determinants (e.g. ethnocentrism) may lead to these disparities.

To cite this abstract in AMA style:

Wadhwani S, Ge J, Gottlieb L, Lyles C, Beck AF, Bucuvalas J, Kotagal U, Lai JC. The Confluence of Race, Socioeconomic Deprivation, and Waitlist Mortality for Children Awaiting Liver Transplant [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-confluence-of-race-socioeconomic-deprivation-and-waitlist-mortality-for-children-awaiting-liver-transplant/. Accessed May 16, 2025.

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