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

Introduction: Indigenous populations in the U.S. (IPUS) have disproportionately high burden of end-stage liver disease but are relatively understudied. Methods: This retrospective study merged the SRTR dataset (2004-2024) with U.S. census data to estimate the exposure to SDOH. Results: 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 LT compared to non-IPUS patients (sHR 0.92; 95%CI 0.85-0.99), but had similar risks of waitlist mortality, post-LT mortality, and graft failure. Conclusion: IPUS face SDOH challenges and lower rates of LT after waitlisting but can still achieve post-LT outcomes similar to non-IPUS patients.