S2831 Racial Disparities in Liver Transplantation and Outcomes in Patients With Severe Drug-Induced Liver Injury: A Multicenter Analysis From the DILIN Prospective Study

Introduction: Drug-induced liver injury (DILI) is a rare but serious cause of acute liver failure, often requiring liver transplantation in severe cases. While prior studies show that Black patients may have worse outcomes, it remains unclear whether disparities in mortality and transplant access persist among patients with comparable severity of DILI. This study examines racial differences in outcomes and receipt of liver transplantation among patients with severe DILI, using data from a multicenter prospective cohort. Methods: We conducted an analysis of patients with severe DILI enrolled in the DILIN prospective study. Severe DILI was defined as a DILIN severity score of 4 or 5. Patients were categorized by race, and key variables including age group, sex, and comorbidity burden were assessed using chi-square tests. Multivariable logistic regression was used to estimate adjusted odds ratios for 2 outcomes: mortality and receipt of liver transplantation. Statistical significance was defined as a P-value < 0.05. Results: Among 598 patients with severe DILI, the cohort was predominantly White, 40-59 years of age and woman. Black patients had significantly increased odds of mortality compared to White patients (AOR: 1.92, 95% CI: 1.02-3.62). Age was a strong predictor of mortality, with patients aged >60 years having increased odds of mortality compared to those aged 20–39 years (AOR: 8.0, 95% CI: 3.88-16.51). Mortality was also marginally higher in patients with ≥5 comorbidities. Importantly, the receipt of liver transplantation was associated with significant lower odds of mortality, highlighting its critical role in patient outcomes (AOR: 0.10, 95% CI: 0.04-0.27). Black race, older age, male sex, and higher comorbidity burden were all associated with lower odds of transplantation, though these associations did not reach statistical significance. Conclusion: This study reveals racial disparities in outcomes among patients with severe DILI, with Black patients experiencing higher mortality despite comparable disease severity. Although differences in liver transplantation rates by race did not reach statistical significance, likely due to limited sample size, the observed trend toward lower odds of transplantation among Black patients raises concerns about potential inequities in access despite liver transplant being significantly associated with reduced mortality. Implementing equity-focused evaluation criteria may help reduce preventable mortality in vulnerable populations affected by severe DILI.