Disparities in mortality worsen among liver transplantation recipients from 2002 to 2018
Among liver transplantation recipients, Black recipients vs. white and Hispanic recipients continue to have a survival disadvantage, according to a study in the American Journal of Transplantation.
“Our mediation analysis provides insights to address ongoing race disparities. First, the effects of a number of biologic and environmental recipient-donor factors which form the basis of most [United Network for Organ Sharing]-based studies mediated only the minority of the Black vs. white disparity, and most do not mediate the paradoxical Hispanic survival benefit, which suggests that studies may be overlooking variables accounting for the bulk of race disparities in [liver transplantation (LT)] survival,” Brian P. Lee, MD, from the division of gastroenterology and liver diseases at University of Southern California, Los Angeles, and colleagues wrote.
Between 2002 and 2018, Lee and colleagues identified 46,997 liver transplantation recipients. Of these, 3,898 were Black, 36,560 were white and 6,539 were Hispanic. Differences in post-liver transplantation mortality among races were calculated with logistic regression and Cox proportional-hazard models. Correlations between transplant year and race were assessed. Biologic and environmental factors correlated with race differences and post-liver transplantation survival were evaluated.
“In most years, Black (vs. white) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics,” Lee and colleagues wrote.
Results from multivariable analysis showed Black patients compared with white patients had higher risk of mortality (adjusted HR = 1.15, 95% CI 1.07-1.24) vs. Hispanic patients who had lower risk of mortality (aHR = 0.78, 95% CI 0.72-0.83). Between 2008 and 2009, differences in post-liver transplantation mortality among Black patients vs. white patients narrowed; however, these differences remained similar between 2010 and 2019 and then worsened between 2014 and 2018, Lee and colleagues noted.
According to researchers, race differences were larger for mortality past 1-year post liver-transplantation vs. within 1 year of transplantation and among patients without HCV compared with those with HCV. From 2010 to 2018, alcohol-related liver disease was strongest mediator of the Black vs. white disparity (13.9%, 95% CI 8.7-32.7%).