Survival after liver transplantation: Is racial disparity inevitable?

Abstract

Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (

Socioeconomic Factors Affect Disparities in Access to Liver Transplant for Hepatocellular Cancer

“…In a separate study, this group determined that African Americans and Asians had similar liver transplant rates compared to Whites, but Hispanics had an 8% lower transplant rate compared to Whites, and subgroups of Asian candidates with higher MELD scores had a 46% lower transplant rate [6, 16]. Differences in transplant may also be due to timing of referral to a transplant center as several studies have demonstrated that African Americans and ethnic minorities had delayed referral or higher MELD score at the time of referral [17–19]. Other factors affecting transplant access include insurance status and distance from the transplant center [20–22].…”

Liver Transplantation in the Ethnic Minority Population: Challenges and Prospects

“…A recent study analyzed data from the UNOS registry (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), showing a significant difference in patient and graft survival for Asians in comparison with non-Asians, with 5-year survival of 71%, 68%, 67%, and 57% for Asians, Hispanic, Caucasian, and African Americans, respectively [26]. Of interest, a recent study based on clinical data obtained from four high-volume US liver transplant centers found no ethnic difference in either patient or graft survival [13]. The reason for this discrepancy with other published studies is unclear.…”

“…Severity of disease at time of referral to a transplant center is only a crude marker of referral patterns, but in the absence of prospective studies, is the best available indicator. In a multicenter US-based study, Lee et al [13] recently reported that African Americans were referred for transplantation at a higher MELD compared with other ethnic groups, suggesting delayed referral. Eckhoff et al [14], in a single-center study, also found that ethnic minorities appeared to be associated with delayed referral for liver transplantation.…”

Donor Race Does Not Predict Graft Failure After Liver Transplantation

“…Although it is possible that immunologic differences or other genetically determined incompatibility between the donor and the recipient of discordant races may lead to worse survival, evidence is lacking to support such a hypothesis 4,5. Further, it is common for racial disparity in health outcome to turn out to be attributable to other socioeconomic factors for which race is merely a surrogate indicator 6,7. The real danger of misusing race as an indicator of poor donor quality is that minority donors will be thought of automatically as marginal donors and may be directed preferentially to marginal recipients, creating a self-fulfilling prophecy that may be very difficult to disprove with future analyses.…”