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SAN FRANCISCO – Preliminary data from a new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that African-American patients on waitlists for liver transplantation, despite severe disease and high scores for prioritization, persistently face significant disparities and delays in referral.
To prioritize liver transplantation recipients, the Model for End Stage Liver Disease, or MELD, scoring system is widely used. However, disparities in timely referral for liver transplantation persist. This study by researchers in the Alameda Health System in Oakland, Calif., evaluated race- and ethnicity-specific disparities in the severity of liver disease of patients at the time of waitlist registration and the time of liver transplantation across the United Network for Organ Sharing, or UNOS, regions in the United States.
“Prior studies had conflicting data on how the adoption of the MELD scoring system for liver allocation had affected racial disparities in liver transplantation. In particular, ethnic minorities − specifically African-Americans − consistently had lower rates of receiving liver transplantation and higher rates of death while awaiting liver transplantation,” says Ann Robinson, MD, an internist at Highland Hospital in Oakland, Calif., and the study’s co-author. “We aimed to specifically evaluate whether these disparately worse outcomes among African-Americans also extended to differences in liver disease severity at [the] time of waitlist registration. The finding of more severe liver disease, as manifested by higher MELD scores, suggests potential delays in referral for liver transplantation among African-Americans. This is critical information to understand, as delays in timely referral may ultimately affect survival outcomes.”
The researchers retrospectively evaluated UNOS liver transplantation data from 2005 to 2016 to compare race- and ethnicity-specific MELD scores at the time of waitlist registration and at the time of liver transplantation among U.S. adults without hepatocellular carcinoma, a type of liver cancer. They compared MELD scores between the groups, and adjusted race- and ethnicity-specific comparisons of these scores for factors like age, sex, year, liver disease etiology, body mass index, ascites and hepatic encephalopathy.
Among 88,542 waitlist registrants for liver transplantation, the researchers found the overall average MELD at the time of registration was 17.4 ± 8.6. African-American patients had a significantly higher average MELD score at waitlist registration than all other race/ethnic groups across all years and regions. All non-white racial and ethnic minorities were significantly more likely to have a higher MELD scores at time of waitlist registration compared to non-Hispanic white patients, with African-American patients having the greatest disparity, the study shows. Similar trends were seen at the time of liver transplantation, with African-American and Hispanic patients having significantly higher MELD scores compared to non-Hispanic whites.
“African-Americans had significantly higher MELD scores at time of liver transplantation waitlist registration, which was observed even after correcting for potential geographic variations. This is particularly important, given that prior data suggested that ethnic disparities may be a direct result of geographic differences,” explains Dr. Robinson of the study’s findings. “While the process of liver transplantation referral is complex and affected by multiple factors, our observations raise serious concerns about persisting race/ethnicity-specific disparities in liver transplantation in the U.S. that need to be studied further so that targeted interventions may be developed to mitigate these disparities.”
Editor’s note: This study was sponsored by AASLD Foundation through its Clinical and Translational Research Award in Liver Diseases.
Dr. Robinson will present these findings at AASLD’s press conference in Room 312-314 at the George R. Moscone Convention Center in San Francisco on Saturday, November 10 from 4:00 PM – 5:30 PM. The study entitled “African Americans Have Significantly Higher Model for End Stage Lier Disease Scores at Time of Liver Transplant Waitlist Registration across All Liver Transplant Regions” will be presented on Sunday, November 11 at 4:30 PM in Room 153/155. The corresponding abstract (number 0164) can be found in the journal, HEPATOLOGY.