Women, African Americans less likely to get liver transplant referral

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Women, African Americans and patients covered by Medicare with liver-related conditions are less likely to be referred and evaluated for a liver transplant, according to a University of Pittsburgh School of Medicine study.

The study, published in the September issue of the American Journal of Transplantation, says race, gender and insurance status influence decisions on who goes on to receive liver transplants.

"Ours is the first major study to look at whether everyone with liver-related conditions has a fair shot of being considered for transplantation and points out that many patients are being excluded from this practice," said Cindy L. Bryce, Ph.D., lead author and associate professor of medicine at Pitt.

The study followed 144,507 patients hospitalized in Pennsylvania with liver-related conditions and sought to determine whether any potential barriers exist at the referral and listing steps in the transplantation process.

The study found that 4,361 of those patients underwent transplant evaluation. Of that group, 3,071 were wait-listed and 1,537 went on to have a transplant.

Disparities were especially apparent in the early stages, when evaluation and listing occurs, the study showed. Sixty-one percent of men were evaluated for transplantation compared to 39 percent of women; 73.8 percent of white patients were evaluated compared to 8.6 percent of black patients; and 62 percent of patients with commercial insurance were evaluated compared to 4.7 percent with Medicare only.

Dr. Bryce said the study "was not designed to identify causes for these disparities." However, she added, "current practices for identifying and referring liver disease patients for transplantation should be made more transparent.

"Although we face a worsening gap in the supply and demand for organs for liver transplantation, race, gender and insurance status should not be factors that preclude patients from being evaluated for transplantation."

More details in tomorrow's Pittsburgh Post-Gazette.


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