DISPARITIES IN TRANSPLANT-FREE SURVIVAL BUT NOT PROGNOSTIC MODELS IN PRIMARY SCLEROSING CHOLANGITIS
Recommended Citation
Yazdanfar M, Zepeda JB, Dean R, Patel IJ, Levy C, Goldberg DS, Lammert C, Prenner S, Reddy K, Pratt D, Forman L, Assis DN, Montano‐Loza AJ, Lytvyak E, Gordon SC, Carey EJ, Ahn J, Schlansky B, Korzenik JR, Karagozian R, Hameed B, Chandna S, Yu L, Bowlus CL. DISPARITIES IN TRANSPLANT-FREE SURVIVAL BUT NOT PROGNOSTIC MODELS IN PRIMARY SCLEROSING CHOLANGITIS. Hepatology 2022; 76:S1506-S1507.
Document Type
Conference Proceeding
Publication Date
10-1-2022
Publication Title
Hepatology
Abstract
Background: African Americans (AA) listed for liver transplantation have been shown to be listed at a younger age and with a higher MELD score. Our aim was to compare the transplant-free survival (TFS) of primary sclerosing cholangitis (PSC) in AA and non-Hispanic Whites (NHW). Methods: Patients diagnosed with PSC alive without liver transplantation after 2008 who were enrolled in the Consortium for Autoimmune Liver Diseases (CALiD) registry were included. Cirrhosis was defined as cirrhotic morphology on imaging, TE >14.4 kPa, MRE >4.93 kPa, or APRI >2. Socioeconomic status (SES) was imputed by % state-wide median income by ZIP code. Mayo risk score (MRS), AmsterdamOxford Model (AOM) and MELD were calculated from the earliest available data. Results: A total of 850 patients were in the dataset including 661 (77.8%) nonHispanic whites (NHW), 85 (10.0%) AA, 50 (5.9%) Hispanic whites, and 54 (6.3%) other unknown. NHW and AA did not differ in median (IQR) age at diagnosis [39.0 yrs (26.0-53.0) vs 40.0 yrs (27.0-49.0), P=0.61], gender (65.2% vs 55.3% male, P=0.07), or PSC type (83.4% vs 85.9% large duct, P=0.26). In contrast, IBD was more frequent in NHW compared to AA (75.8% vs 51.8%, P=0.0001). Baseline (NWH vs AA) AST [46.0 (30.0-83.0) vs 57.0 (40.0-113.0), P=0.04) and platelets [215 (148.0-286.0) vs 255 (187.0-354.0), P=0.02] were higher in AA while albumin was lower [4.0 (3.5-4.3) vs 3.7 (3.1-4.1), P=0.001]. There were no differences in ALP, ALT, total bilirubin, or INR. AOM was lower in NHW [14.3 (13.4-15.2) vs 15.1 (14.1-15.7), P=0.002] but MRS [0.03 (-0.8-1.1) vs 0.02 (-0.7-1.0), P=0.83], MELD [5.9 (2.8-10.7) vs 6.4 (2.6-10.4) , P=0.95], and cirrhosis (27.4% vs 27.1%, P=0.95) did not differ. TFS was significantly lower in AA compared to NHW (P=0.014) but did not differ by SES (P=0.07) (Figure). Significant predictors of TFS (HR, 95%CI) in multivariable analysis included age at diagnosis (1.04, 1.02-1.06, P<0.0001), total bilirubin (1.06, 1.04-1.08, P<0.0001), and albumin (0.44, 0.33-0.61, P<0.0001), but not AA race (1.77, 0.83-3.77, P=0.14) or SES (>140% median 0.69, 0.26- 1.79, P=0.44). Neither AA race nor SES was a significant predictor of TFS when added to MRS, AOM, or MELD scores. Conclusion: AA with PSC have a lower TFS compared to NHW. However, clinical factors and not AA race or SES are independent predictors of TFS.
Volume
76
First Page
S1506
Last Page
S1507
