Increased Waitlist Mortality and Lower Rate for Liver Transplantation in Hispanic Patients With Primary Biliary Cholangitis

Abstract

In an analysis of data from UNOS registry focusing on outcomes, we observed differences in rates of LT and liver transplant waitlist mortality of Hispanic patients compared with white patients with PBC. Further studies are needed to improve our understanding of ethnicity and race-based differences in progression of PBC.

More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

“…Previous studies have shown better waitlist survival in Hispanic patients with HCV, leading to speculation that the population has slower disease progression . In contrast, Hispanics with PBC, a group not featured in this study, have been found to have higher waitlist mortality . Further, the literature has noted that the term Hispanics cover heterogeneous groups culturally, ethnically, and socioeconomically, thereby allowing the potential for a disproportionate effect from a subgroup to mask variability experienced by other subgroups .…”

Emerging therapies for PBC

“…It is debatable whether AMAnegative and AMA-positive biliary cholangitis even represent the same disease entity, though there appears to be a genetic association. Younger age of onset and male gender as well as African and Hispanic descent portend a poorer prognosis and it is not clear why [32][33][34][35]. Biomarkers of disease severity are otherwise lacking, or in their infancy of development, though autotaxins and the microbiome are being studied as well as other potential markers [36,37].…”

Primary Biliary Cholangitis Guidance Update: Implications for Liver Transplantation

“…(2) When nonwhite patients are listed, they are usually younger and with higher severity scores compared with white patients. In another study, Hispanics had the highest percentage of wait-list mortality (20.8%) compared with other races and ethnicities and were less likely to actually receive a LT. (3) The recently published 2018 American Association for the Study of Liver Diseases (AASLD) PBC guidance document incorporates recommendations on the use of obeticholic acid as second-line therapy. (4) Patients whose serum alkaline phosphatase remains elevated above 1.5-2 times the upper limit of normal after a year of treatment with UDCA have shortened survival compared with biochemical responders.…”

“…When nonwhite patients are listed, they are usually younger and with higher severity scores compared with white patients. In another study, Hispanics had the highest percentage of wait‐list mortality (20.8%) compared with other races and ethnicities and were less likely to actually receive a LT …”