Survival after liver transplantation: Is racial disparity inevitable?

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Liver Failure/Cirrhosis/Portal Hypertension

Survival after liver transplantation: Is racial disparity inevitable?

Tae Hoon Lee 1, Nilay Shah 2, A. Pedersen 3, Walter K. Kremers 3, B. Rosen 1, Goran B. Klintmalm 4, W. Ray Kim 1 2 *

1 J. von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, MN2Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN3Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN4Baylor Transplant Institute, Baylor University Medical Center, Dallas, TX

email: W. Ray Kim (kim.ray@...)

*Correspondence to W. Ray Kim, Division of Gastroenterology and Hepatology (PL 6), 200 1st Street SW, Rochester, MN 55905Potential conflict of interest: Nothing to report.fax:

Funded by: National Institute of Diabetes and Digestive and Kidney Diseases; Grant Number: DK-34238, DK-61617

Abstract

Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8% [95% confidence interval (CI): 86.0-95.9] for African Americans, 86.5% (95% CI: 85.1-87.9) for Caucasians, and 84.4% (95% CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2% (95% CI: 60.1-79.7) for African Americans, 72.2% (95% CI: 70.1-74.4) for Caucasians, and 67.5% (95% CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4% (95% CI: 41.1-72.1), for Caucasians 50.7% (95% CI: 46.4-55.3), and for other races 55.7% (95% CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis.

Conclusion: These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians. (HEPATOLOGY 2007.)

Received: 1 February 2007; Accepted: 19 May 2007

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