Independent effect of black recipient race on short-term outcomes after liver transplantation

Quillin, Ralph C.; Wilson, Gregory C.; Wima, Koffi; Hanseman, Dennis J.; Sutton, Jeffrey M.; Shaw, Joshua; Cuffy, Madison C.; Woodle, E. Steve; Paquette, Ian M.; Abbott, Daniel E.; Shah, Shimul A.

doi:10.1016/j.surg.2014.10.018

Cited by 27 publications

(33 citation statements)

References 31 publications

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“…Our study did not find any association between race and early hospitalization rates. Consistent with previous studies, our study found that African American race was associated with a 38% increased risk of death after adjusting for recipient and donor factors. Historically, African Americans have lower response rates to the peg‐interferon–based treatment.…”

Section: Discussionsupporting

confidence: 92%

National assessment of early hospitalization after liver transplantation: Risk factors and association with patient survival

et al. 2017

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Hospitalization is known to occur frequently in the first 6 months following liver transplantation (LT). Using a novel data linkage between the Scientific Registry of Transplant Recipients and Centers for Medicare and Medicaid Services, our study has two objectives: (i) determine risk factors for “early” hospitalization (i.e., within 6 months of LT) (ii) quantify the importance of hospitalization history in the first 6 months with respect to subsequent patient survival (i.e., survival, conditional on surviving 6 months post-LT). Methods The study population consisted of patients aged ≥18 years who underwent deceased donor LT between January 1, 2003, and December 31, 2010, with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n = 7,220). Results The early hospitalization rate was 2.76 per patient-year and was significantly associated with many recipient factors (e.g., recipient age, hepatitis C, diabetes, poor renal function including dialysis and recipient of TIPSS procedure before LT), as well as donor race and donation after cardiac death (DCD). Conditional on surviving 6 months post-LT, the covariate-adjusted death rate increased by 22% for each additional hospitalization occurring in the first 6 months (HR=1.22; p<0.001). Conclusions Several LT recipient factors are significantly associated with early hospitalization. Moreover, a patient’s hospitalization profile during follow-up months 0–6 is a very strong predictor of survival thereafter. Efforts and resources should be devoted towards identifying LT recipients at risk for early hospitalization and modifying the actionable risk factors such as hepatitis C, diabetes and BMI to improve resource utilization and overall outcomes.

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Section: Discussionsupporting

confidence: 92%

National assessment of early hospitalization after liver transplantation: Risk factors and association with patient survival

et al. 2017

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“…Previous studies examining post‐transplant outcomes in minority groups have mainly focused on black recipients and find decreased short‐ and long‐term survival . These findings are proposed to be a result of several factors such as healthcare access, socioeconomic status, prevalence and distribution of chronic liver diseases, differences in immunosuppressive effects, and genetic variations, among others .…”

Section: Introductionmentioning

confidence: 99%

“…Although Hispanic patients share many of these pre‐ and post‐transplant risk factors, in addition to cultural and language barriers, there is limited data on survival outcomes in Hispanic patients. For instance, one study showed improved short‐term survival compared with white recipients, while others found no differences in outcomes for Hispanic recipients . However, no data exist for long‐term follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes after liver transplantation in the Hispanic population

Ochoa-Allemant

Ezaz

Trivedi

et al. 2019

Liver International

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Background & Aims: Racial/ethnic disparities in liver transplantation (LT) are wellrecognized. Although Hispanics represent the largest and youngest minority group in the United States, limited data exist on long-term outcomes. We aimed to investigate long-term post-liver transplant outcomes in Hispanic patients and identify potential disparities compared to a baseline demographic of non-Hispanic white patients. Methods: We performed a retrospective cohort study of first-time liver transplant recipients using the United Network for Organ Sharing database from 2002 to 2013, with follow-up through 2018. The primary outcomes of interest were overall patient and graft survival after LT. Results: 45 767 patients underwent LT (85.0% non-Hispanic white, 15.0% Hispanic).Hispanics had lower socioeconomic status, higher prevalence of pretransplant comorbidities and more severe liver disease compared to non-Hispanic whites. Hispanics had similar patient (76.6% vs 75.6%; P = .12) and graft (71.7% vs 70.8%; P = .28) survival at 5 years and significantly better patient (62.9% vs 59.7%; P < .001) and graft (58.6% vs 55.6%; P = .002) survival at 10 years. In multivariable analysis, Hispanics had lower associated all-cause mortality (HR 0.86, 95% CI, 0.82-0.91; P < .001) and graft failure (HR 0.89, 95% CI, 0.85-0.93; P < .001) compared to non-Hispanic whites.In etiology-specific subanalysis, Hispanics transplanted for ALD, NASH and HCV had lower all-cause mortality compared to non-Hispanic whites.

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“…[5][6][7][8][9]10 Historically, African American (AA) recipients have shown inferior graft and patient survival rates compared with White, Hispanic, Asian, and other recipients both before and during the MELD era. [5][6][7]11 Many have tried to elucidate reasons why AA patients typically experience inferior graft and patient outcomes after liver transplant.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,8,12 Reports vary regarding outcomes in White and Hispanic recipients. Some have demonstrated that White recipients experience survival advantages over Hispanic recipients, 5,9 whereas others have reported that Hispanic recipients experience superior outcomes compared with White recipients. 6,10 Data are scarce regarding biologic, disease-related, and socioeconomic factors …”

Section: Discussionmentioning

confidence: 99%

Untitled

Brooks

Wong²,

Koizumi³

et al. 2018

Exp Clin Transplant

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Results: There were significant differences in 1-and 2-year graft and patient survival rates between ethnicities pre-Share 35 (P = .03, P < .001, P = .01, P < .001, respectively). There were no significant differences in 1-and 2-year graft and patient survival between ethnicities post-Share 35 (P = .268, P = .09, P = .343, P = .087, respectively). There were no differences in early graft failure rates pre-and postShare 35 at 7 days (2.1% vs 2.0; P = .71) and 30 days (4.0% vs 3.8%; P = .47) after transplant, with a decreased early graft failure rate shown at 90 days after transplant (6.8% vs 5.8%; P = .003). When analyzed separately, the low Model for End-Stage Liver Disease (score of < 35) and the high Model for End-Stage Liver Disease recipients (score of ≥ 35) both exhibited reduced early graft failure rates post-Share 35 (6.1% vs 5.3% and 10.8% vs 7.8%, respectively; P < .05). Conclusions: Share 35 was associated with a short-term reduction in ethnic disparities. Most ethnic groups experienced improved survival in the Share 35 era. Share 35 was not associated with an increase in early graft failure and is an efficacious policy with regard to short-term outcomes.

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Independent effect of black recipient race on short-term outcomes after liver transplantation

Cited by 27 publications

References 31 publications

National assessment of early hospitalization after liver transplantation: Risk factors and association with patient survival

National assessment of early hospitalization after liver transplantation: Risk factors and association with patient survival

Long‐term outcomes after liver transplantation in the Hispanic population

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