Social Determinants of Health and Liver Transplant Outcomes in U.S. Indigenous Populations.

Abstract

Indigenous populations in the United States (IPUS) have disproportionately high burden of end-stage liver disease but are relatively understudied. This retrospective study merged the Scientific Registry of Transplant Recipients Data set (2004-2024) with U.S. census data to estimate the exposure to social determinants of health (SDOH). Of 164,294 patients, 0.9% identified as IPUS and resided in areas with more vulnerable SDOH ( P < 0.001). They were less likely to receive liver transplantation (LT) compared with non-IPUS patients (subdistribution hazard ratio 0.92; 95% confidence interval 0.85-0.99), but had similar risks of waitlist mortality, post-LT mortality, and graft failure. IPUS face SDOH challenges and lower rates of LT after waitlisting but can still achieve post-LT outcomes similar to non-IPUS patients.