Comparing donor selection barriers for living donor liver transplantation among Hispanic and non-Hispanic candidates in a large urban center.

Hispanics represent the largest-growing ethnic group awaiting liver transplantation. Though racial/ethnic barriers to living donor liver transplantation have been described among recipients, little is known about challenges for minority living liver donor (LLD) candidates during donor evaluation. We aimed to characterize LLD candidates and compare donor-related barriers by ethnicity through a single-center retrospective cohort study of all LLD referrals from December 2017 to August 2021. The primary outcome was LLD approval with OR estimated using multivariable logistic regression. Among 1508 candidates (694 Hispanic, 814 non-Hispanic), 303 (20.1%) failed initial screening; Hispanics were more often screened out for body mass index >35 kg/m 2 (73% vs. 55%, p =0.003). Of 1205 passing screening (533 Hispanic, 672 non-Hispanic), Hispanics were younger [median age 34 (IQR 26-44) vs. 40 (32-51)], more often directed donors (97% vs. 90%), and spouses/first-degree relatives of the recipient (52% vs. 29%, all p <0.001). In the multivariable model adjusted for donor-recipient relationship, Hispanic ethnicity was associated with higher odds of LLD approval (OR 1.48, 95% CI 1.01-2.17, p =0.04). Living donor liver transplantation disparities among Hispanics may involve factors preceding donor evaluation or independent of the donor. Optimizing Hispanic LLD candidacy, establishing a registry of individuals referred for LLD, and conducting multicenter studies are warranted.