The effect of donor race on post-liver transplant outcomes according to liver disease etiologies

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Conference Proceeding

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Background: Previous studies revealed that compared to Whites, Hispanics are more susceptible to nonalcoholic fatty liver disease (NAFLD) and African-Americans have a lower risk of NAFLD, in part, because of genetic variations in PNPLA3. However, the effect of donor race on post-liver transplant (LT) outcomes in NAFLD patients has not been well investigated. The aim of this study is to assess the effect of donor race on post-LT outcomes in white patients according to liver disease etiologies. Methods: This study used data from the UNOS registry and evaluated White adult patients who underwent LT for hepatitis C virus (HCV), non-alcoholic steatohepatitis (NASH), alcohol-related liver disease (ALD), and cholestatic liver disease (CLD) between 2015 and 2019. Patients who received multi-organ transplant, LT from donation after circulatory death donor, living donor LT, and re-LT, and those with hepatocellular carcinoma were excluded. Conditional 5-year post-LT outcomes were defined as outcomes after 6 months post-LT. Patients who died within 6 months after LT were removed from the analysis. Risks of conditional 5-year graft loss were compared between donor races in each disease. Risks were adjusted by recipient and donor factors at LT and were analyzed using the Cox proportional hazards models. Results: Among 10,592 patients eligible for the analysis of post-LT outcomes, 7,056 (66.6%), 1,990 (18.8%), 1,177 (11.1%), 219 (2.1%), and 150 (1.4%) patients had White, African-American, Hispanic, Asian, and other race donors, respectively. In patients with HCV, African-American donors had significantly higher adjusted risk of conditional 5-year graft loss than White donors (adjusted hazard ratio [aHR] 1.67, P=0.008) whereas risks were comparable between White and Hispanic donors. In those with NASH, African-American and Hispanic donors had similar adjusted risks of conditional 5-year graft loss compared to White donors whereas Asian donors had higher risk than Caucasian donors (aHR 2.27, P=0.020). In those with ALD or CLD, risks were comparable between donor races (Figure). Conclusion: In NASH, ALD, and CLD recipients, the use of African-American or Hispanic donors was not associated with better or worse post-LT outcomes whereas African-American donors had significantly higher risk of graft loss in HCV recipients.

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