Racial Disparities in Graft and Patient Survival After Orthotopic Liver Transplantation

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: There is limited data on the influence of race on graft rejection and survival after liver transplantation. Our study is the largest to investigate racial disparities in outcomes after primary liver transplantation since the implementation of the Model for End-Stage Liver Disease (MELD) classification system. We sought to determine if there is a difference in graft survival and patient survival in African Americans (AA) compared to white Americans after liver transplantation. Methods: Data on liver transplantations between 1988 and 2021 was obtained from the United Network of Organ Sharing (UNOS) transplant registry. The registry contained complete follow up data for 326,005 patients. A propensity type of match was used to match 3 white patients for each of the AA patients. The pool of data extracted included information on recipient age, gender, race, ABO blood group, donor type, donor age, body-mass index (BMI), Model for End-Stage Liver Disease (MELD) score at time of transplant, graft and patient survival time. Statistical Analysis Software (SAS) for Windows, version 9.4, Cary NC was used for all analyses. Categorical variables were examined with Chi-square tests and are provided as counts and (%) frequencies. Results: Graft failure rates between whites and AA on day 30 post liver transplant (4.5% vs 5.0%, P=0.036), 1 year (13.0% vs 14.9%, P< 0.0001), 3 years (23.5% vs 28.3%, P< 0.0001) and 5 years (32.8% vs 38.9%, P< 0.0001). Additionally, patient mortality between whites and AA at day 30 (3.4% vs 3.8%, P=0.90), 1 year (11.2% vs 13.1%, P< 0.0001), 2 years (21.3% vs 26.3%, P< 0.0001), 5 years (30.4% vs 36.7%, P< 0.0001). Both were adjusted for age, gender, BMI, Initial MELD score and ABO type. This data resulted in an increasing gap between the 2 racial groups on the Kaplan-Meier plot for graft survival and patient survival. Conclusion: Our study successfully demonstrates that African Americans have a statistically significant higher graft failure and patient survival rate compared to white Americans at 1 year, 3 years and 5 years post-OLT. The reasons for these differences are likely multifactorial in nature. The results of this study highlight the need for further research to understand the factors affecting the survival outcomes of different racial/ethnic groups and address disparities in healthcare (Figure 1, Table 1).

Volume

118

Issue

10

First Page

S1166

Last Page

S1167

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