Addressing Racial Disparities in a Hispanic Population Through Living Donor Liver Transplantation—A Comparison of 2 Eras

INTRODUCTION: Hispanic patients experience lower rates of liver transplant referral and living donation compared to non-Hispanic white (NHW) patients, often due to socioeconomic barriers. This study evaluated the impact of initiating a living donor liver transplant (LDLT) program on waitlist outcomes and ethnic disparities at a single center. METHODS: A retrospective analysis compared Hispanic and NHW waitlist outcomes between two eras: before (Era 1: 2012-2017) and after (Era 2: 2018-2024) LDLT program implementation. Outcomes included LDLT, deceased donor liver transplant (DDLT), death or clinical deterioration (DOD), and clinical improvement. Sub-distribution hazard models and Kaplan-Meier survival analyses were used. RESULTS: 1156 liver transplants were performed in Hispanic and NHW patients. Era 2 patients experienced significantly shorter waitlist times (236 vs. 365 days, p<0.001). NHW patients were more likely to have higher education, be English-speaking U.S. citizens, and be employed. Hispanic LDLT recipients more often had biologic donors. LDLT likelihood increased significantly in Era 2 (HR = 5.77, p<0.001), while waitlist DOD rates decreased by 48% (HR = 0.52, p<0.001). NHW patients had a higher chance of LDLT (HR = 1.67, p<0.001) and lower DOD risk (HR = 0.70, p = 0.001) than Hispanic patients, although DOD decreased for both groups. Women had a higher rate of LDLT (HR = 1.58) but also higher DOD (HR = 1.26). In Era 1, Hispanic LDLT recipients had worse post-transplant survival, but outcomes improved to match NHW recipients in Era 2 (p = 0.88). CONCLUSION: Implementation of a LDLT program improved access and waitlist outcomes for all groups, especially Hispanic, despite significant socioeconomic barriers, and female patients.