Original Article

Comparisons between White and Black Patients Hospitalized with Postliver Transplant Complications/Failure

Authors: Sherifatu Abu, MD, MPH, Po-Hung Chen, MD, Ché Matthew Harris, MD

Abstract

Objectives: The impact of race on patients presenting to North American hospitals with postliver transplant complications/failure (PLTCF) has not been studied fully. We compared in-hospital mortality and resource utilization outcomes between White and Black patients hospitalized with PLTCF.

Methods: This was a retrospective cohort study that evaluated the years 2016 and 2017 from the National Inpatient Sample. Regression analysis was used to determine in-hospital mortality and resource utilization.

Results: There were 10,805 hospitalizations for adults with liver transplants who presented with PLTCF. White and Black patients with PLTCF made up 7925 (73.3%) hospitalizations from this population. Among this group, 6480 were White (81.7%) and 1445 were Black (18.2%). Blacks were younger than Whites (mean age ± standard error of the mean: 46.8 ± 1.1 vs 53.6 ± 0.39 years, P < 0.01). Blacks were more likely to be female (53.9% vs 37.4%, P < 0.01). Charlson Comorbidity Index scores were not significantly different (scores ≥3: 46.7% vs 44.2%, P = 0.83). Blacks had significantly higher odds for in-hospital mortality (adjusted odds ratio 2.9, confidence interval [CI] 1.4–6.1; P < 0.01). Hospital charges were higher for Blacks compared with Whites (adjusted mean difference $48,432; 95% CI $2708–$94,157, P = 0.03). Blacks had significantly longer lengths of hospital stays (adjusted mean difference 3.1 days, 95% CI 1.1–5.1, P < 0.01).

Conclusions: Compared with White patients hospitalized for PLTCF, Black patients had higher in-hospital mortality and resource use. Investigation into causes leading to this health disparity is needed to improve in-hospital outcomes.
Posted in: Gastroenterology56 Liver Disease8

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References

1. Ammori JB, Pelletier SJ, Lynch R, et al. Incremental costs of post-liver transplantation complications. J Am Coll Surg 2008;206:89–95.
 
2. Jadlowiec CC, Taner T. Liver transplantation: current status and challenges. World J Gastroenterol 2016;22:4438–4445.
 
3. Eghtesad B, Miller C, Fung J. Cleveland Clinic Digestive Disease and Surgery Institute: post-liver transplant management. https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/post-liver-transplantation-management. Published August 2010. Accessed November 21, 2022.
 
4. Quillin RC 3rd, Wilson GC, Wima K, et al. Independent effect of black recipient race on short-term outcomes after liver transplantation. Surgery 2015;157:774–784.
 
5. Ross-Driscoll K, Kramer M, Lynch R, et al. Variation in racial disparities in liver transplant outcomes across transplant centers in the United States. Liver Transpl 2021;27:558–567.
 
6. Neff GW, Kemmer N, Kaiser T, et al. Outcomes in adult and pediatric liver transplantation among various ethnic groups. Transplant Proc 2007;39:3204–3206.
 
7. Ross K, Lynch R, Patzer R. Racial disparities in post-liver transplant survival before and after Share 35 implementation [abstract]. https://atcmeetingabstracts.com/abstract/racial-disparities-in-post-liver-transplant-survival-before-and-after-share-35-implementation/. Accessed November 21, 2022.
 
8. Lo AX, Donnelly JP, Durant RW, et al. A national study of U.S. emergency departments: racial disparities in hospitalizations for heart failure. Am J Prev Med 2018;55(5 suppl 1):S31–S39im.
 
9. Kiechle JE, Abouassaly R, Gross CP, et al. Racial disparities in partial nephrectomy persist across hospital types: results from a population-based cohort. Urology 2016;90:69–74.
 
10. Harris CM, Khaliq W, Albaeni A, et al. The influence of race in older adults with infective endocarditis. BMC Infect Dis 2020;20:146.
 
11. Agency for Healthcare Research and Quality. Healthcare cost and utilization project. User support: NIS overview. https://hcup-us.ahrq.gov/nisoverview.jsp. Accessed June 27, 2021.
 
12. Houchens R, Ross D, Elixhauser A. HCUP Methods Series calculating National Inpatient Sample (NIS) variances for data years 2012 and later. Report #2015-09. https://hcup-us.ahrq.gov/reports/methods/2015_09.jsp. Published December 10, 2014. Accessed 2015.
 
13. Wahid NA, Rosenblatt R, Brown RS Jr. A review of the current state of liver transplantation disparities. Liver Transpl 2021;27:434–443.
 
14. Wong RJ, Ahmed A. Combination of racial/ethnic and etiology/disease-specific factors is associated with lower survival following liver transplantation in African Americans: an analysis from UNOS/OPTN database. Clin Transplant 2014;28:755–761.
 
15. Pelletier SJ, Isaacs RB, Raymond DP, et al. Ethnic disparities in outcome from posttransplant infections. Shock 2004;22:197–203.
 
16. Nephew L, Zia Z, Ghabril M, et al. Black adult patients with acute liver failure are sicker and more likely to undergo liver transplantation than White patients. Liver Transpl 2019;25:1634–1641.
 
17. Giglia MD, DeRussy A, Morris MS, et al. Racial disparities in length-of-stay persist even with no postoperative complications. J Surg Res 2017;214:14–22.
 
18. Sukumar S, Ravi P, Sood A, et al. Racial disparities in operative outcomes after major cancer surgery in the United States. World J Surg 2015;39:634–643.
 
19. Statista. Number of liver transplants performed in the U.S. in January 2023, by state. https://www.statista.com/statistics/954207/us-liver-transplants-by-state/. Accessed July 7, 2021.
 
20. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.
 
21. Rosenblatt R, Wahid N, Halazun KJ, et al. Black patients have unequal access to listing for liver transplantation in the United States. Hepatology 2021;74:1523–1532.
 
22. Nephew LD, Serper M. Racial, gender, and socioeconomic disparities in liver transplantation. Liver Transpl 2021;27:900–912.
 
23. Nobel YR, Forde KA, Wood L, et al. Racial and ethnic disparities in access to and utilization of living donor liver transplants. Liver Transpl 2015;21: 904–913.
 
24. Chin MH, Walters AE, Cook SC, et al. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev 2007;64(5 suppl): 7S–28S.
 
25. OPTN/SRTR 2016 annual data report: preface. Am J Transplant 2018; 18(suppl 1):1–9.