# Disparities in Liver Transplantation Among Native Americans and Hispanic Individuals: Insights from a Southwest Region Center in the United States of America

## TL;DR

Native American and Hispanic patients face significant barriers to liver transplants and higher waitlist mortality compared to white patients.

## Contribution

This study identifies racial disparities in liver transplant access and outcomes in a U.S. Southwest region center.

## Key findings

- Native American and Hispanic patients had lower rates of liver transplant evaluation and listing compared to white patients.
- Waitlist mortality was significantly higher for Native American and Hispanic patients than for white patients.
- Financial barriers were more common among Native American and Hispanic patients.

## Abstract

Background: Liver transplantation (LT) is the definitive treatment for end-stage liver disease, yet racial and ethnic disparities persist across the LT continuum. This study investigated the patient-level and system-level barriers to LT and evaluated racial disparities in access and outcomes. Methods: We conducted a retrospective cohort study (2012–2022) at Banner University Medical Center, Phoenix, analyzing adult LT-referred, evaluated, waitlisted, and transplanted patients. Primary outcomes included mortality and LT barriers, assessed using competing-risk and Cox regression analyses. Results: Among 2877 LT-referred patients, 61% were Non-Hispanic White (NHW), 26% Hispanic, 8.8% Native American/Alaska Native (NA/AN), 3% Black, and 1% Asian. Compared with NHW patients, lower rates of LT evaluation and listing were observed among NA/AN (39% and 53%) and Hispanic patients (56% and 63%) versus NHW patients (51% and 64%). Patient-level financial barriers were more common among NA/AN (15.5%) and Hispanic (19.81%) individuals. Waitlist mortality was significantly higher for NA/AN (sub-distribution hazard ratio [SHR]: 5.26; p < 0.01) and Hispanic (SHR: 2.92, p < 0.02) patients than for NHW patients, whereas graft survival did not differ significantly by race. Conclusions: Marked racial and ethnic disparities exist in LT access and waitlist mortality, particularly among NA/AN and Hispanic patients. Targeted interventions addressing financial and systemic barriers are critical to ensuring equitable LT access and improving transplant outcomes.