Epidemiology

No racial gap seen in liver transplantation outcomes

Last Updated: 2008-06-05 11:10:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Caucasians, African Americans, Hispanics, and Asians who undergo primary liver transplantation now have comparable 5- and 10-year patient and graft survival rates, new research suggests. In the 1980s and early 1990s, by contrast, several studies reported lower patient and graft survival rates for African Americans and Asians.

According to the report that appears in the Journal of the American College of Surgeons for May, this is the first study to find no racial disparities in long-term liver transplantation outcomes. The authors believe that much of the credit in equalizing outcomes goes to the introduction of tacrolimus into immunosuppressive regimens.

"Survival rates after liver transplantation have been shown to be influenced by race, but earlier data on this subject has been conflicting and may not reflect current management of liver transplant recipients," lead author Dr. Johnny C. Hong said in a statement.

In the new study, Dr. Hong from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues analyzed data from 817 patients who underwent transplantation between 1984 and 1993, when cyclosporine was the primary immunosuppressive agent, and from 1922 patients transplanted between 1994 to 2007 when tacrolimus was the primary drug.

As noted, in the earlier era, African Americans and Asians had inferior outcomes compared with the other racial groups. For instance, the 10-year patient survival rate for Caucasians was 61%, while the rate for African Americans was 50%.

In the later era, patients and graft survival rates were similar for the different ethnic groups. During this period, the 10-year survival rate for African Americans and Caucasians was nearly identical, roughly 65%.

In addition to transplantation during the earlier period, other predictors of diminished patient survival were recipient or donor age greater than 55 years and liver failure secondary to cryptogenic cirrhosis, malignancy, or hepatitis C. Additional predictors of graft failure included prolonged cold ischemia time and acute rejection.

"Although our study is the first to find equivalent long-term outcomes among racial groups after liver transplantation, access to care for all patients with end-stage liver disease clearly remains a major goal for all transplant centers," Dr. Hong emphasized. "Like many diseases, our patients are best served with early involvement of a multidisciplinary team."

J Am Coll Surg 2008.