Does Race Influence Outcomes after Primary Liver Transplantation? A 23-Year Experience with 2,700 Patients - 01/11/17

Doi : 10.1016/j.jamcollsurg.2007.12.019

Johnny C. Hong, MD, Kambiz Kosari, MD, Elizabeth Benjamin, MD, John P. Duffy, MD, R. Mark Ghobrial, MD, PhD, FACS, Douglas G. Farmer, MD, FACS, Hasan Yersiz, MD, Junming Xu, MD, Jonathan R. Hiatt, MD, FACS, Ronald W. Busuttil, MD, PhD, FACS ^⁎
Dumont-UCLA Transplant Center, Pfleger Liver Institute, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA.

Correspondence address: Ronald W Busuttil, MD, PhD, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 10833 Le Conte Ave, Room 77–120 CHS, Box 957054, Los Angeles, CA 90095–7054.

Résumé

Background

Data about the influence of race on survival after liver transplantation (LT) are limited and conflicting. This study was undertaken to evaluate longterm outcomes for LT in African-American (AA) recipients compared with recipients of other races and to determine factors responsible for any observed differences.

Study Design

This was a retrospective case series. Among 2,728 adult patients who underwent primary LT from 1984 to 2007, 1,566 (57%) were Caucasian, 761 (28%) were Hispanic, 290 (11%) were Asian, and 111 (4%) were AA. The primary immunosuppressive agent was cyclosporine from 1984 to 1993 (Era I, n=817) and tacrolimus from 1994 to 2007 (Era II, n=1922).

Results

In Era I, the 1-, 5- and 10-year patient and graft survival figures for AA and Asian recipients were considerably lower compared with Caucasian and Hispanic recipients. In Era II, patient and graft survival figures were comparable for all groups. Statistically significant independent predictors of diminished patient survival included LT in Era I; recipient or donor age greater than 55 years; and liver failure secondary to cryptogenic cirrhosis, malignancy, or hepatitis C. Predictors of graft failure included LT in Era I; recipient or donor age greater than 55 years; prolonged cold ischemia time; liver failure secondary to hepatitis C, cryptogenic cirrhosis, or malignancy; and acute rejection. Patient and graft survival were independent of race in both eras.

Conclusions

This is the first study to demonstrate equivalent longterm results after LT for AA and other races. Modern immunosuppression with tacrolimus substantially lowered rejection rates and improved graft and patient survival after LT.

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Abbreviations and Acronyms : AA, CyA, DGF, ESLD, LT, PNF, TAC