Abstract
State-Wise Racial Disparities in Liver Transplant Across Three MELD Eras: An UNOS/OPTN Data Analysis
American journal of transplantation, Vol.26(1 Supplement 1), p.S56
01/2026
DOI: 10.1016/j.ajt.2025.12.127
Abstract
Introduction: The Model for End-Stage Liver Disease (MELD) system has undergone three policy changes: MELD (2002-2015), MELD-Na (2016-2023), and MELD-3.0 (2023-present).However, inequities in liver transplant access persist across the U.S. Here, we examined the state-level trends among racial subgroups across MELD eras and compared national conversion and waitlist mortality rates to assess the efficacy of each policy change.
Methods: We conducted a retrospective, population-level study using the Organ Procurement and Transplantation Network (OPTN) data on 190,725 liver transplant waitlist additions, 177,944 transplants, and 18,039 waitlist deaths from 1995 to June 2025. Transplant metrics were analyzed across three MELD eras by race, state of residency, and sex, with pre-MELD years (before 2002) included for descriptive context. Caucasian patients served as the reference group. Primary analysis used difference-in-differences (DiD) to evaluate state-level shifts for African Americans versus Caucasians. Secondary analysis compared national conversion and mortality rates across major racial and sex strata.
Results: Inferences were limited to MELD and MELD-Na due to insufficient MELD 3.0 data. State-level DiD estimators revealed insignificant MELD era shifts for conversion (+0.012 pp, p =0.38) or mortality rates (+0.002 pp, p = 0.83). African American patients had higher conversion rates, while Asians and Hispanics had lower rates in both MELD eras. Additionally, females fared better than males (+4.2 pp, p < 0.001) in each era. In the MELD era, Hispanics had the highest [14.2 % (OR 1.25, p < 0.001)], while Asians [9.1 % (OR 0.76, p < 0.001)] and African Americans[9.6 % (OR 0.81, p< 0.001)] had lower waitlist mortality rates, with no difference among sexes. Similar trends were observed in the MELD-Na era, except for African Americans and maleHispanics, whose differences from Caucasians under MELD where insignificant [6.6 % (0.91, p =0.11)].
Conclusion: Minimal state-level shifts across MELD eras suggest limited impact of regional policies on transplant equity. Racial disparities among waitlisted patients persisted, questioning the efficacy of MELD policy changes. Our findings highlight the need for race-conscious reforms, community outreach, and equity-focused research, though conclusions remain limited with MELD3.0 still in its infancy.
Details
- Title: Subtitle
- State-Wise Racial Disparities in Liver Transplant Across Three MELD Eras: An UNOS/OPTN Data Analysis
- Creators
- Muhammad Nasir - University of Cincinnati Medical CenterMuhammad Mehdi - King Edward Medical UniversityManzer Ali - Pakistan Institute of Medical SciencesSangrag Ganguli - University of ChicagoMuhammad Umer - King Edward Medical UniversityMuhammad Tariq - King Edward Medical UniversityAbdul Rizwan - King Edward Medical UniversityHanzala Jehangir - Rutgers, The State University of New JerseyHassan Aziz - University of Iowa
- Resource Type
- Abstract
- Publication Details
- American journal of transplantation, Vol.26(1 Supplement 1), p.S56
- DOI
- 10.1016/j.ajt.2025.12.127
- ISSN
- 1600-6135
- Publisher
- Elsevier
- Language
- English
- Date published
- 01/2026
- Academic Unit
- Surgery
- Record Identifier
- 9985130061702771
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