Liver Transplant Survival Rates Lower in Black than White Pediatric Patients

December 2013

"Racial and Socioeconomic Disparities in Pediatric and Young Adult Liver Transplant Outcomes," published in the December edition of Liver Transplantation, describes novel research that found racial and socioeconomic disparities among pediatric liver transplant patients and graft and patient survival rates that were higher in white children than minorities. Emory transplant and epidemiology researcher Dr. Rachel Patzer was the senior author of the study, and Dr. Rekha Thammana, a second-year Emory internal medicine resident in the primary care tract, was first author.

For patients with end-stage liver disease (ESLD), liver transplantation is the only treatment option for survival. Studies show that over the last 30 years pediatric patient survival, at one year following liver transplant, is 90% compared to 70% prior to 1980. Experts suggest that as survival rates improve, understanding racial and socioeconomic differences in pediatric populations are important factors to consider for overall health status.

"Little is known about the impact of race, ethnicity, and socioeconomic status disparities on outcomes after liver transplantation among pediatric and adolescent recipients," explains Dr. Thammana. "Our study is the first to investigate the impact of race and socioeconomic status on graft and patient survival among white and minority children."

The researchers reviewed data from 208 pediatric and young adult liver transplant recipients, aged 22 or younger, who received a first liver transplant at Children's Hospital of Atlanta between 1998 and 2008 and were followed through 2011. They looked at information on individual race, clinical, demographic, and socioeconomic factors from hospital records, referrals to Georgia Transplant Foundation, and United Network for Organ Sharing (UNOS) data.

Results show that 51% of transplant recipients were white, 35% were black, and 14% were other races or ethnicities. Graft and patient survival was higher among whites vs. minorities at one, three, five, and 10 years post-transplant. The 10-year graft survival was 84% for white, 60% among black, and 49% for the remaining minority patients. Patient survival at 10 years post-transplant was 92%, 65%, and 76% among whites, blacks, and other races, respectively.

Further analyses show that graft failure and mortality rates remained higher among minority groups compared to white children after accounting for differences in demographic, clinical, and socioeconomic factors. "It is unclear why these racial/ethnic disparities exist in this pediatric population, and it is unknown whether these disparities are concentrated in the Southeast or persist across the nation," concluded Dr. Patzer. "Further investigation of the reasons for racial and ethnic differences is necessary to identify interventions that may help reduce disparities in pediatric liver transplantation."