# Liver Transplant-Community Access for Referral Equity (LT-CARE) Pilot Study

> **NIH NIH R21** · INDIANA UNIVERSITY INDIANAPOLIS · 2024 · $244,320

## Abstract

ABSTRACT
Cirrhosis is the end-result of chronic liver disease mainly viral hepatitis, metabolic dysfunction-associated
steatohepatitis, and alcohol-related liver disease. The only life-saving treatment for decompensated cirrhosis is
liver transplant (LT). Despite the critical need for this lifesaving therapy, there remain significant inequities in
accessing LT. While a myriad disparities and barriers exist in the LT care pathway, the largest number of
patients in the pathway are in the community awaiting the first step-referral. Previous studies have revealed
disparities in LT referrals, with lower odds for Black individuals (OR, 0.19), the uninsured (OR, 0.40), and
specific hospital sites (OR, 0.40). Nationally, the waitlist capture rate for decompensated cirrhosis was 0.4 for
White individuals and 0.3 for Black individuals; in Indiana, the ratio was only 0.2, ranking in the bottom 5% of
all states. At Indiana University Health (IUH), the sole LT center in Indiana, only 5.8% of LT referrals were Black
individuals, and less than 1% were Hispanic/Latino/a/x ethnicity.
Many patients experiencing health disparities seek medical care at community gastroenterology (GI) practices
where clinicians may not have access to transplant hepatologists and may lack knowledge of specialized
evidence-based protocols and policies. This is exacerbated by factors like limited provider time, potential
biases, complexities in navigating the healthcare system, and differing levels of patient literacy and unmet
social needs, all of which impede referral. Furthermore, there is variability among community GI practices,
including size (i.e. small vs. large) and location (i.e. rural vs. urban), directly impacting the resources available
and the capacity to support both providers and patients through the referral process. There is an urgent and
unmet need to develop an intervention that addresses this variability but also acknowledges the structural and
social barriers faced by patients and caregivers, ultimately improving referral equity. There is currently no
multilevel intervention addressing the lack of equitable access to LT. The study team proposes to adapt
LT-CARE, a multi-component referral toolkit to address barriers at multiple socioecological levels and improve
equity in LT referral. The study team will use community-based research methods to adapt a usable,
acceptable, and feasible toolkit for community GI practices, their patients, and caregivers.

## Key facts

- **NIH application ID:** 11057773
- **Project number:** 1R21MD020222-01
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Lauren Nephew
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $244,320
- **Award type:** 1
- **Project period:** 2024-09-22 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11057773

## Citation

> US National Institutes of Health, RePORTER application 11057773, Liver Transplant-Community Access for Referral Equity (LT-CARE) Pilot Study (1R21MD020222-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11057773. Licensed CC0.

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