S2629 Racial Disparities in Liver Transplant Hospitalizations in the United States: Insights From a Nationwide Hospitalization Study

Introduction: Racial disparities in healthcare outcomes remain a critical concern, particularly in specialized fields such as organ transplantation. Liver transplant recipients often face complex health trajectories, with hospitalization rates serving as a key metric of post-transplant health and access to care. This study uses the NIS database to examine racial differences in liver transplant hospitalizations, aiming to identify contributing factors and promote equitable outcomes. Methods: We performed a retrospective analysis using the National Inpatient Sample (2016–2020) to evaluate liver transplant hospitalizations identified by International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients were grouped by race: White (reference), Black, Hispanic, and Other. Outcomes included admission type (elective vs emergent), discharge disposition (home, facility, home healthcare, or death), length of stay, and hospitalization costs. Multivariate regression adjusted for age, sex, insurance, geography, and hospital factors to assess racial disparities. Results: A total of 2,87,279 Liver transplant hospitalizations were identified, with 68.1% being White, 8.7% being Black, 13% Hispanic and 10% being other racial groups. The average of all hositalisations is 59 years and 60.7% were woman. Whites primarily sought care in the Southern US (39.6%), followed by the Midwest (24.4%), Northeast (19.8%), and West (15.9%). Blacks also predominantly sought care in the Southern US (49.5%), with fewer in the Midwest (23.7%), Northeast (18.7%), and West (8%). Hispanics sought care in the Western US (40.8%) and Southern (34.5%) in roughly equal proportions which aligns with the geographical distribution of these patients. Other race were mostly evenly distributed, Midwest (29%), followed by West (28%), South (24%) and Northeast (17%) [P < 0.001]. Multivariate regression analysis revealed that, Hispanics had lower odds of mortality compared to Whites [OR 0.76, P < 0.03]. In comparison to Whites, Blacks had shorter length of stay [OR 0.9, P value = 0.03] and Hispanics had higher length of stay [OR 1.07, P value = 0.04]. Total charges were lower for Blacks [β -5685, P < 0.007], and higher in Hispanics [β 11892, P < 0.001]. Conclusion: Our analysis reveals persistent racial disparities in liver transplant hospitalizations, including mortality, length of stay, and costs—especially among Black and Hispanic patients. Findings highlight the need for targeted strategies to improve access, post-transplant care, and outcomes, advancing equity in liver transplantation.