Racial differences in fibrosis progression after HCV-related liver transplantation

Abstract

Background: Black recipients undergoing liver transplantation (LT) for hepatitis C virus (HCV) have decreased patient and graft survival compared with white recipients, a finding that is primarily limited to black recipients of livers from white donors. The cause(s) for these discrepant outcomes are unclear but may be related to HCV disease recurrence. The rates of HCV-related disease recurrence and liver fibrosis progression among black and white liver transplant recipients have not been investigated.

Methods: In this study, we compared liver fibrosis progression between 105 black and 364 white recipients after HCV-related LT in a multisite cohort study and assessed the impact of donor race.

Results: At 6, 12, and 24 months after LT, there was a significantly higher percentage in the black recipient/white donor (B/W) group with severe fibrosis, defined as stage 3 or 4 (F3/F4), compared with all other recipient/donor race combinations. The adjusted odds ratio of developing F3/F4 for the B/W group was 2.54 (1.49-4.69; reference group, white recipient/white donor). Black recipients with black donors demonstrated a similar rate of progression to F3/F4 as white recipients. Patient survival was also decreased in the B/W group compared with other recipient/donor race combinations.

Conclusion: African American recipients with white donors have more severe fibrosis progression after HCV-related LT. The mechanisms responsible for accelerating fibrosis progression in this high-risk race-mismatched group need to be investigated.

Figure 1

Figure 1a: Percent of patients with fibrosis stage 3/4 by recipient race Figure 1b: Percent of patients with fibrosis stage 3/4 by recipient/donor race combination W: White; B: Black; F3/F4: Fibrosis stage 3 or 4

Figure 2

Figure 2a: One, two, and five-year patient mortality rate post-transplant by recipient/donor race Figure 2b: One, two, and five-year patient mortality rate post-transplant based on fibrosis progression W: White, B: Black; F3/F4: Fibrosis stage 3 or 4