The effect of donor race on the survival of Black Americans undergoing liver transplantation for chronic hepatitis C

Abstract

The purpose of this study was to determine the effect of donor race on the outcome of black patients with chronic hepatitis C infection who undergo liver transplantation. The records for deceased donor liver transplants that occurred in the United States between January 1998 and December 2007 were obtained from the United Network for Organ Sharing. 26,212 records contained sufficient data to be included in the analysis. Of these, 11,989 (45.7%) records were for patients positive for hepatitis C virus (HCV) and 1292 (4.9%) were for patients both HCV-positive and black. Black recipients with white donors were found to have significantly worse outcomes than all other recipient-donor race combinations (P < 0.001). The crude 5-year survival rate for black recipients who had a black donor was 14% higher than the 5-year survival rate for black recipients who had a white donor. Multivariate regression analysis determined that a graft from a race-unmatched donor was an independent risk factor for graft failure (hazard ratio = 1.41, 95% confidence interval = 1.11-1.79) among HCV-positive black recipients but not among HCV-negative black recipients after adjustments for donor age, recipient age, cold ischemia time, serum creatinine, serum bilirubin, diabetes mellitus, body mass index, and donor cytomegalovirus status. The observation that race-unmatched grafts are a risk factor in HCV-positive black recipients, but not in HCV-negative black recipients, suggests an alteration of the graft-host relationship by HCV. In conclusion, our results suggest that HCV-positive black recipients who undergo liver transplantation can have increased graft survival if their donors are black, with survival rates approaching those of white liver transplant recipients.

Figure 1. Kaplan-Meier survival curves

HCV-positive white versus HCV-positive black liver transplant recipients.

Figure 2. Kaplan-Meier graft survival curves

A. HCV-positive liver transplant recipients, by recipient-donor race. B. HCV-negative liver transplant recipients, by recipient-donor race. In panels A and B, the number of patients at risk in each cohort is indicated.

Figure 3. Degree of HLA Match between Recipient and Donor in HCV-Infected Liver Transplant Patients

The cumulative percent of patients by HLA match (A, B, and DR loci) is illustrated in the bar graphs (top), from 6/6 match (left) to 0/0 match (right). Actual percent numbers are given in the table below. *P-value for an HLA match level ≥ 3/6, using Fisher’s exact test; **P-value for an HLA match level ≥ 3/6, using Chisquared statistic, which was necessary given the large number of white transplant patients. See text for additional statistics.