Racial and spatial disparities in liver transplant acceptance in the United States Restricted; Files Only

Abstract

Little is known about how transplant center behaviors are associated with liver transplant offer acceptance rates and whether this may result in racial and spatial disparities in acceptance. Liver transplant offer acceptance refers to a transplant center’s acceptance of a given donor organ on a candidate’s behalf. Recent OPTN organ allocation policies have shifted transplant center behaviors, specifically in organ offer practices. We examined the association between transplant center behaviors and liver transplant acceptance in the United States from 2020-2021 upon implementation of updated OPTN organ allocation policies. We obtained data from the Scientific Registry of Transplant Recipients (SRTR) and performed a multiple linear regression model to assess the association between the racial and spatial distribution of a transplant center’s patient population and that center’s liver acceptance rate. Candidate demographics and center-level characteristics were described to ascertain variation across centers. Rates of offer acceptance responses were represented visually by race and distance to a transplant center. Rates of acceptance within racial groups remained consistent across all groups. Distance to a transplant center did not prove significant in liver transplant acceptance. While no significant association between transplant center behaviors and liver transplant acceptance was found, there was substantial variation in liver transplant acceptance across individual centers. Examination of transplant center behaviors and how they may play a role in transplant outcomes is imperative to ensuring equitable transplant outcomes.

Table of Contents

BACKGROUND 1

Introduction 1

History of liver transplantation 1

History of MELD scores 2

MELD score mechanics 2

US organ allocation system 3

Match run mechanics 3

Transplant center behaviors 4

Race-specific trends in liver transplantation 5

Geographic trends in liver transplantation 5

Public health implications and study purpose 6

INTRODUCTION 7

METHODS 9

RESULTS 11

DISCUSSION 13

REFERENCES 16

TABLES AND FIGURES 19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palavra-chave	Health Equity Transplant Research Health Services
Committee Chair / Thesis Advisor	Katherine Ross-Driscoll, PhD, MPH, Emory University

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