African Americans and Asians have a worse outcome than white Americans and Hispanics after liver transplantation, both in terms of graft rejection and survival, according to a new Hopkins-led study reported in the Jan. 26 issue of The Lancet.
Scientists analyzed data on age, sex, race, blood group, and cause of death of donors and recipients from the United Network of Organ Sharing (UNOS) registry for all liver transplants done between 1988 and 1996 in the United States.
"Our results show that outcomes two years after surgery were considerably lower for African Americans and Asians than for white Americans," says Paul Thuluvath, M.D., associate professor of medicine and medical director of liver transplantation in the Division of Gastroenterology and Hepatology at Hopkins and lead author of the paper.
While the low outcomes for Asians are influenced by the number of patients with hepatitis B, the cause for low survival in African Americans remains unclear. What is clear, says Thuluvath, is that more studies need to be done to determine why African Americans are faring less well than other races.
"Until then, the reasons for poor survival in African Americans will remain speculative," says Thuluvath.
The scientists report that two-year graft survival for African Americans (601 of 884, 68 percent) and Asians (266 of 416, 64 percent) was significantly lower than white Americans (8703 of 11,762, 74 percent) and Hispanics (878 or 1220, 72 percent). Likewise, two-year survival was significantly lower for African Americans (74 percent) and Asians (69 percent) than for white Americans (83 percent) and Hispanics (79 percent).
"In terms of risk, African Americans are 34 percent more likely to die from liver transplant than white Americans," says Thuluvath. "And Asians had an increased risk profile of 25% compared with white Americans."
Thuluvath and colleagues are now investigating claims that poor survival in African Americans is due to such socioeconomic factors as poor compliance with postoperative care, and lack of insurance benefits. Preliminary data on 500 liver transplant patients treated at Hopkins suggest that socioeconomic factors are not at fault, and Thuluvath is analyzing more than 30,000 liver transplant cases in the United Network of Organ Sharing to determine the extent to which socioeconomic factors can be implicated.
Other authors are Sateesh Nair, M.D., and Joseph Eustace, M.D., of Johns Hopkins.
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Journal
The Lancet