Outcomes among undocumented immigrants undergoing liver transplant: A nationwide retrospective cohort.

Abstract

Undocumented immigrants face significant barriers to health care access, including organ transplantation. However, their post-liver transplant outcomes remain poorly understood. This study evaluates graft survival and overall survival among undocumented immigrants undergoing liver transplant compared with US citizens. A retrospective cohort study was conducted using the Scientific Registry of Transplant Recipients database, including adult liver transplant recipients from 1987 to 2022. The primary outcomes were 1-year graft survival and 5-year overall survival, analyzed using Fine-Gray competing risks and Cox proportional hazards models. A total of 88,603 adult liver transplant recipients were included, with 1,331 (1.5%) identified as undocumented immigrants. Compared with US citizens, undocumented immigrants had a lower body mass index (27.4 vs 28.1 kg/m²), lower diabetes prevalence (0.2% vs 4.4%), and higher rates of alcohol-associated liver disease (53.9% vs 43.9%) (all P < .05). Median Model for End-Stage Liver Disease with Sodium Adjustment scores (undocumented immigrant: 21 vs US citizen: 18) and wait times (undocumented immigrant: 105 vs US citizen: 95 days) were statistically different (P < .001) but clinically similar. In unadjusted analyses, undocumented immigrants had higher 1-year graft survival (hazard ratio: 0.27, 95% confidence interval: 0.19-0.39) and 5-year overall survival (hazard ratio: 0.49, 95% confidence interval: 0.42-0.58) than US citizens (P < .05). Adjusted analyses found no significant differences in 1-year graft survival (hazard ratio: 0.79, 95% confidence interval: 0.20-3.15) or 5-year overall survival (hazard ratio: 0.68, 95% confidence interval: 0.35-1.32) (both P > .05). Post-liver transplant survival among undocumented immigrants was comparable to US citizens after adjustment. These findings support policies that enhance equitable liver transplant access while maintaining comparable outcomes.