TOPLINE:

Hospitalized patients with severe alcohol-associated hepatitis from disadvantaged neighborhoods were less likely to be referred for a liver transplant when their disease severity was moderate. Disease severity and neighborhood deprivation were also linked to waitlisting and mortality risk.

METHODOLOGY:

• Researchers conducted a secondary analysis of a prospective cohort of adults hospitalized with severe alcohol-associated hepatitis at five US transplant centers (May 2019-November 2023) to assess whether disease severity and neighborhood disadvantage affected access to liver transplants.
• Clinical severity was measured using the Model for End-Stage Liver Disease (MELD) score, with higher scores indicating more severe liver disease. All patients had baseline scores > 20.
• Neighborhood disadvantage was assessed using the Area Deprivation Index (ADI), a composite score ranging from 1 to 100 and linked to patients’ zip codes, with higher scores indicating greater deprivation.
• The primary outcomes were referral for transplant evaluation, waitlisting, and receipt of a transplant, and the secondary outcome was 180-day all-cause mortality.

TAKEAWAY:

• The analysis included 325 patients (mean age, 44.8 years; 60.6% male). Only 36.9% of patients were referred for transplant, 48.3% of the referred patients were wait-listed, 55.2% of the waitlisted patients received a transplant, and 25.5% died within 180 days.
• In adjusted analyses, each 1-point increase in the MELD score was associated with a 13% increase in the odds of referral (P < .001), a 10% increase in the odds of waitlisting (P = .02), a 24% increase in the odds of receiving a transplant (P = .004), and a 7% increase in the odds of 180-day mortality (P < .001).
• Greater neighborhood deprivation was linked to modestly reduced odds of waitlisting (P = .02) but was not significantly associated with overall referral, transplant receipt, or mortality. Significant interactions between MELD and ADI were observed for referral, waitlisting, and 180-day mortality (P ≤ .01 for all).
• At MELD scores of 20-30, referral probability fell from about 50% in low-deprivation areas (ADI < 30) to under 20% in high-deprivation areas (ADI ≥ 30), with similar ADI-related gradients observed for waitlisting and 180-day mortality.

IN PRACTICE:

“At the community level, targeted outreach and navigation may support patients at high risk, particularly those from disadvantaged neighborhoods. At the transplant center level, standardizing evaluation protocols, integrating [social determinants of health] into clinical workflows, and equity-informed multidisciplinary review may reduce disparities in listing. At the policy level, funding for navigation programs and inclusion of social risk metrics in program evaluation may promote fair and timely access to [liver transplant] for [severe alcohol-associated hepatitis],” the authors of the study wrote.

SOURCE:

The study was led by Lauren D. Nephew, MD, MSCE, Indiana University School of Medicine, Indianapolis. It was published online in JAMA Network Open.

LIMITATIONS:

Transplant decisions were captured retrospectively, limiting insight into clinician decision-making. Postdischarge social support and substance use and medical contraindications or comorbidities were not assessed. Small samples at later steps and large site-to-site variation may have reduced statistical power and generalizability.

DISCLOSURES:

The study was supported by multiple grants from various agencies, including the National Institute on Minority Health and Health Disparities, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute of General Medical Sciences. Some authors reported receiving consulting fees, personal fees, grants, and having equity interests from industry entities outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.