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. 2021 Aug;27(8):1154-1164.
doi: 10.1002/lt.26054. Epub 2021 Apr 21.

Black Race Is Associated With Higher Rates of Early-Onset End-Stage Renal Disease and Increased Mortality Following Liver Transplantation

Meagan Alvarado  1 , Douglas E Schaubel, K Rajender Reddy, Therese Bittermann
Affiliations

Black Race Is Associated With Higher Rates of Early-Onset End-Stage Renal Disease and Increased Mortality Following Liver Transplantation

Meagan Alvarado et al. Liver Transpl. 2021 Aug.

Abstract

Black race is a risk factor for end-stage renal disease (ESRD). Racial disparities in the risks of early and long-term renal complications after liver transplantation (LT) have not been systematically studied. This study evaluated racial differences in the natural history of acute and chronic renal insufficiency after LT. This was a retrospective single-center cohort study of 763 non-Hispanic White and 181 Black LT recipients between 2008 and 2017. Black race was investigated as an independent predictor of the following outcomes: (1) receipt and duration of early post-LT hemodialysis and (2) time to post-LT ESRD. The interaction of race and post-LT ESRD on survival was also studied. Black recipients had higher rates of pre-LT hypertension (P < 0.001), but diabetes mellitus and renal function before LT were not different by race (all P > 0.05). Overall, 15.2% of patients required early hemodialysis immediately after LT with no difference by race (covariate-adjusted odds ratio, 0.89; P = 0.71). Early dialysis discontinuation was lower among Black recipients (covariate-adjusted hazard ratio [aHR], 0.47; P = 0.02), whereas their rate of post-LT ESRD was higher (aHR, 1.91; P = 0.005). Post-LT survival after ESRD was markedly worse for Black (aHR, 11.18; P < 0.001) versus White recipients (aHR, 5.83; P < 0.001; interaction P = 0.08). Although Black and White LT recipients had comparable pretransplant renal function, post-LT renal outcomes differed considerably, and the impact of ESRD on post-LT survival was greater for Black recipients. This study highlights the need for an individualized approach to post-LT management to improve outcomes for all patients.

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Conflict of interest statement

Disclosures

The authors have no conflicts of interest to disclose.

Conflicts of interest: The authors of this manuscript firmly declare no conflicts of interest related to this study.

Figures

Figure 1:
Figure 1:
Unadjusted mean eGFR trends by race in the first 5 years post-LT Footnote: In the figure above, eGFR=0 when creatinine value measured while patient was on hemodialysis. Creatinine values were included in eGFR calculations until liver re-transplantation, kidney transplantation or end of follow-up. Asterix represents two-sided t-test p<0.05.
Figure 2:
Figure 2:
Adjusted survival according to post-LT ESRD status among White (A) and Black (B) recipients
See this image and copyright information in PMC

References

    1. Allen AM, Kim WR, Therneau TM, Larson JJ, Heimbach JK, Rule AD. Chronic kidney disease and associated mortality after liver transplantation--a time-dependent analysis using measured glomerular filtration rate. Journal of hepatology. 2014;61(2):286–292. - PMC - PubMed
    1. Ojo AO, Held PJ, Port FK, et al.Chronic renal failure after transplantation of a nonrenal organ. The New England journal of medicine. 2003;349(10):931–940. - PubMed
    1. Barreto AG, Daher EF, Silva GB Junior, et al.Risk factors for acute kidney injury and 30-day mortality after liver transplantation. Annals of hepatology. 2015;14(5):688–694. - PubMed
    1. Wang TJ, Lin CH, Chang SN, et al.Long-Term Outcome of Liver Transplant Recipients After the Development of Renal Failure Requiring Dialysis: A Study Using the National Health Insurance Database in Taiwan. Transplantation proceedings. 2016;48(4):1194–1197. - PubMed
    1. Sharma P, Schaubel DE, Guidinger MK, Goodrich NP, Ojo AO, Merion RM. Impact of MELD-based allocation on end-stage renal disease after liver transplantation. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2011;11(11):2372–2378. - PMC - PubMed

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