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Review
. 2021 Aug 3:2021:6692049.
doi: 10.1155/2021/6692049. eCollection 2021.

Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

John Paul Nsubuga  1 , Daniela Goyes  2 , Hirsh D Trivedi  2 , Esli Medina-Morales  2 , Vilas Patwardhan  2 , Alan Bonder  2
Affiliations
Review

Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

John Paul Nsubuga et al. J Transplant. .

Abstract

Background: Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes.

Aim: To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. Study. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan-Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis.

Results: African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1-1.58, P=0.046) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98-1.23, P=0.081).

Conclusions: Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.

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Conflict of interest statement

The authors have no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Competing risk analysis for cumulative incidence of death or waitlist removal for clinical deterioration with transplant as competing risk.
Figure 2
Figure 2
Unadjusted Kaplan–Meier estimates comparing graft survival (composite of posttransplant death and retransplant by race).
Figure 3
Figure 3
Competing risk analysis for cumulative incidence of death with retransplantation as competing risk.
Figure 4
Figure 4
Competing risk analysis for cumulative incidence of retransplantation with death as competing risk.
See this image and copyright information in PMC

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