Unresolved Disparities: Sex, Racial, Ethnic, and Insurance Differences in Performance Status at Listing for Liver Transplant
Center for Liver Disease and Transplantation, New York, NY
Meeting: 2020 American Transplant Congress
Abstract number: D-129
Keywords: Hispanic, Liver transplantation, Survival, Waiting lists
Session Information
Session Name: Poster Session D: Liver: Recipient Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Cirrhosis is a chronic disease characterized by progressive worsening in physical functioning. We hypothesized that poor performance status at time of listing was an indicator of late referral for LT and would be associated with waitlist (WL) mortality. Therefore, we studied differences in performance status at listing and assessed for possible disparities.
*Methods: UNOS STAR file data for all non-status 1 adults listed of LT (1/1/2006-12/31/2018) were analyzed. The primary outcome was Karnofsky performance score (KPS) – stratified as low (10-40), medium (50-70), and high (> 80). The secondary outcome was waitlist (WL) mortality. Multivariable-logistic regression analyzed factors affecting KPS. Competing risk regression (CRR) analyzed WL mortality.
*Results: Of the 131,599 patients included, 21.3%, 42.5%, and 36.2% had low, medium, and high KPS at listing. KPS worsened in 52.0% of patients by LT or WL removal. Male and Asian patients had higher KPS at listing, while Hispanic, Black, and Medicaid-insured patients had lower KPS at listing (all p<0.001). On regression analysis, women and the interaction of both White with Medicaid and Hispanic with Medicaid had higher odds of low KPS at listing.
| Variable | Low Function | High Function | ||
| Adjusted OR | P-value | Adjusted OR | P-value | |
| Interaction of Race/Ethnicity and Medicaid | ||||
| White, Non-Medicaid | REF | REF | ||
| White, Medicaid | 1.14 (1.04-1.25) | 0.004 | 0.54 (0.50-0.57) | 0.004 |
| African-American, Medicaid | 1.04 (0.85-1.26) | 0.71 | 0.65 (0.58-0.72) | <0.001 |
| Hispanic, Medicaid | 1.19 (1.03-1.39) | 0.02 | 0.53 (0.47-0.60) | <0.001 |
| Female | 1.23 (1.20-1.27) | <0.001 | 0.80 (0.78-0.82) | <0.001 |
In CRR analysis, patients with low KPS at listing, Hispanics, women and those with Medicaid had significantly worse WL mortality (sub-HR 1.07, 1.07, and 1.14, respectively, all p<0.001)
| Variable | Sub-Hazard Ratio | P-value |
| Performance Status at Listing | ||
| High | REF | |
| Low | 1.07 (1.04-1.11) | <0.001 |
| Race/Ethnicity | ||
| White | REF | |
| Hispanic | 1.07 (1.04-1.11) | 0.003 |
| Female | 1.14 (1.12-1.17) | <0.001 |
.
*Conclusions: Significant sociodemographic disparities exist in performance status at listing for LT. As low KPS at listing is associated with increased WL mortality, late referral to LT centers is problematic for vulnerable patient populations (Medicaid patients, women, and Hispanics) and increased outreach is needed.
To cite this abstract in AMA style:
Rosenblatt R, Fortune B, Jesudian A, Lucero C, Brown RS, Samstein B, Emond J, Verna E, Halazun K. Unresolved Disparities: Sex, Racial, Ethnic, and Insurance Differences in Performance Status at Listing for Liver Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/unresolved-disparities-sex-racial-ethnic-and-insurance-differences-in-performance-status-at-listing-for-liver-transplant/. Accessed May 16, 2025.« Back to 2020 American Transplant Congress