In a Large US Cohort, Race Had No Effect on Survival Time of Liver Transplant Recipients

Previous analyses of data from the United Network for Organ Sharing (UNOS) showed that African American (AA) patients undergoing liver transplantation (OLT) had survival significantly inferior to recipients of other races (Lancet 2002). The reason for this disparity is unclear.

The objective of the current study was to compare survival of AA and non-AA OLT recipients and causes of death at high-volume OLT centers.

Two NIH-sponsored multi-center databases prospectively enrolled OLT recipients at 4 centers. Data including demographics, liver disease diagnosis and postOLT follow-up were extracted in 2851 adult patients undergoing primary OLT between 1985 and 2000.

Results

The racial distribution of the cohort included 135 AA (4.8%), 2448 Caucasian, and 240 other race. Similar to the UNOS data, AA recipients were younger than non-AAs (mean ages: 43.1 vs. 49.6, p<.01).

Fulminant hepatic failure was more common (14.8% vs. 4.2%) and alcoholic (7.4% vs. 12.8%) and cholestatic (15.6% vs. 23.6%) disease less common among AAs than non-AAs (p<0.01). The proportion of hepatitis C was similar (21.5% vs. 23.8%).

Subsequent to OLT, 765 recipients died including 35 AAs (4.6% of all deaths).

The authors conclude, survival was indistinguishable between AAs and non-AAs. Graft survival was also similar. In the table that describes causes of death in 716 patients with identifiable causes, there was no difference between AA and non-AA recipients.

Conclusions

In contrast to the nation-wide data from UNOS that showed significantly shorter survival for AA recipients, in this large cohort of carefully selected OLT recipients at high-volume centers, race had no effect on post-OLT survival.

The authors conclude, “These data suggest that patient selection or post-OLT care in these select centers can overcome any biologic differences (e.g., higher incidence of rejection) that may exist across racial categories.

05/24/04

Reference
W R Kim and others. Why Should African American Liver Transplant Recipients Have Poorer Survival Than Others? Abstract 223 (oral). Digestive Disease Week. May 15-20, 2004. New Orleans, LA.