Survival after liver transplantation: Is racial disparity inevitable?

Hoon Lee Tae, Nilay D Shah, Rachel A. Pedersen, Walter K Kremers, Charles B. Rosen, Goran B. Klintmalm, W. Ray Kim

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8% [95% confidence interval (CI): 86.0-95.9] for African Americans, 86.5% (95% CI: 85.1-87.9) for Caucasians, and 84.4% (95% CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2% (95% CI: 60.1-79.7) for African Americans, 72.2% (95% CI: 70.1-74.4) for Caucasians, and 67.5% (95% CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4% (95% CI: 41.1-72.1), for Caucasians 50.7% (95% CI: 46.4-55.3), and for other races 55.7% (95% CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis. Conclusion: These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians.

Original languageEnglish (US)
Pages (from-to)1491-1497
Number of pages7
JournalHepatology
Volume46
Issue number5
DOIs
StatePublished - Nov 2007

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Liver Transplantation
Confidence Intervals
Survival
African Americans
Graft Survival
Prothrombin Time
Kaplan-Meier Estimate
Bilirubin
Proportional Hazards Models
Liver Diseases
Creatinine
Demography
Databases

ASJC Scopus subject areas

  • Hepatology

Cite this

Tae, H. L., Shah, N. D., Pedersen, R. A., Kremers, W. K., Rosen, C. B., Klintmalm, G. B., & Kim, W. R. (2007). Survival after liver transplantation: Is racial disparity inevitable? Hepatology, 46(5), 1491-1497. https://doi.org/10.1002/hep.21830

Survival after liver transplantation : Is racial disparity inevitable? / Tae, Hoon Lee; Shah, Nilay D; Pedersen, Rachel A.; Kremers, Walter K; Rosen, Charles B.; Klintmalm, Goran B.; Kim, W. Ray.

In: Hepatology, Vol. 46, No. 5, 11.2007, p. 1491-1497.

Research output: Contribution to journalArticle

Tae, HL, Shah, ND, Pedersen, RA, Kremers, WK, Rosen, CB, Klintmalm, GB & Kim, WR 2007, 'Survival after liver transplantation: Is racial disparity inevitable?', Hepatology, vol. 46, no. 5, pp. 1491-1497. https://doi.org/10.1002/hep.21830
Tae, Hoon Lee ; Shah, Nilay D ; Pedersen, Rachel A. ; Kremers, Walter K ; Rosen, Charles B. ; Klintmalm, Goran B. ; Kim, W. Ray. / Survival after liver transplantation : Is racial disparity inevitable?. In: Hepatology. 2007 ; Vol. 46, No. 5. pp. 1491-1497.
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title = "Survival after liver transplantation: Is racial disparity inevitable?",
abstract = "Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8{\%} [95{\%} confidence interval (CI): 86.0-95.9] for African Americans, 86.5{\%} (95{\%} CI: 85.1-87.9) for Caucasians, and 84.4{\%} (95{\%} CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2{\%} (95{\%} CI: 60.1-79.7) for African Americans, 72.2{\%} (95{\%} CI: 70.1-74.4) for Caucasians, and 67.5{\%} (95{\%} CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4{\%} (95{\%} CI: 41.1-72.1), for Caucasians 50.7{\%} (95{\%} CI: 46.4-55.3), and for other races 55.7{\%} (95{\%} CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis. Conclusion: These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians.",
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N2 - Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8% [95% confidence interval (CI): 86.0-95.9] for African Americans, 86.5% (95% CI: 85.1-87.9) for Caucasians, and 84.4% (95% CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2% (95% CI: 60.1-79.7) for African Americans, 72.2% (95% CI: 70.1-74.4) for Caucasians, and 67.5% (95% CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4% (95% CI: 41.1-72.1), for Caucasians 50.7% (95% CI: 46.4-55.3), and for other races 55.7% (95% CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis. Conclusion: These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians.

AB - Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8% [95% confidence interval (CI): 86.0-95.9] for African Americans, 86.5% (95% CI: 85.1-87.9) for Caucasians, and 84.4% (95% CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2% (95% CI: 60.1-79.7) for African Americans, 72.2% (95% CI: 70.1-74.4) for Caucasians, and 67.5% (95% CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4% (95% CI: 41.1-72.1), for Caucasians 50.7% (95% CI: 46.4-55.3), and for other races 55.7% (95% CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis. Conclusion: These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians.

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