• Sharad I Wadhwani, Jin Ge, Laura Gottlieb, Courtney Lyles, Andrew F Beck, John Bucuvalas, John Neuhaus, Uma Kotagal, and Jennifer C Lai.
• University of California, San Francisco, San Francisco.
• Hepatology. 2021 Aug 13.

Background And AimsRacial/ethnic minority children have worse liver transplant outcomes. We evaluated whether neighborhood socioeconomic deprivation affected associations between race/ethnicity and waitlist mortality.Approach And ResultsWe included children (age<18 years) listed 2005-2015 in the Scientific Registry of Transplant Recipients. We categorized patients as non-Hispanic White, Black, Hispanic, and other. We matched patient ZIP codes to a neighborhood socioeconomic deprivation index ([range, 0-1]; higher values indicate worse deprivation). Primary outcomes were waitlist mortality, defined as death/delisting for too sick, and receipt of living donor liver transplant (LDLT). Competing risk analyses modeled the association between race/ethnicity and waitlist mortality, with deceased donor liver transplant (DDLT) and LDLT as competing risks; and race/ethnicity and LDLT, with waitlist mortality and DDLT as competing risks. Of 7,716 children, 17% and 24% identified as Black and Hispanic, respectively. Compared to White children, Black and Hispanic children had increased unadjusted hazard of waitlist mortality (subhazard ratio [sHR], 1.44; 95% confidence interval [CI], 1.18, 1.75 and sHR, 1.48; 95% CI, 1.25, 1.76, respectively). After adjusting for neighborhood deprivation, insurance, and listing lab Model for End-Stage Liver Disease (MELD)/Pediatric End-Stage Liver Disease (PELD), Black and Hispanic children did not have increased hazard of waitlist mortality (sHR, 1.12; 95% CI, 0.91, 1.39 and sHR, 1.21; 95% CI, 1.00, 1.47, respectively). Similarly, Black and Hispanic children had decreased likelihood of LDLT (sHR, 0.58; 95% CI, 0.45, 0.75 and sHR, 0.61; 95% CI, 0.49, 0.75, respectively). Adjustment attenuated the effect of Black and Hispanic race/ethnicity on likelihood of LDLT (sHR, 0.79; 95% CI, 0.60, 1.02 and sHR, 0.89; 95% CI, 0.70, 1.11, respectively).ConclusionsHousehold and neighborhood socioeconomic factors and disease severity at waitlist entry help explain racial/ethnic disparities for children awaiting transplant. A nuanced understanding of how social adversity contributes to waitlist outcomes may inform strategies to improve outcomes.This article is protected by copyright. All rights reserved.

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