Long‐term outcomes after liver transplantation in the Hispanic population. (18th September 2019)

• Record Type: Journal Article
• Authors: Ochoa‐Allemant, Pedro; Ezaz, Ghideon; Trivedi, Hirsh D.; Sanchez‐Fernandez, Lady; Bonder, Alan
• Is Part Of: Liver international. Volume 40:Number 2(2020)
• Page Start: 437
• Page End: 446
• Publication Date: 2019-09-18
• Subjects: end–stage liver disease -- healthcare disparities -- Hispanic -- liver transplantation -- survival analysis; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14248
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: Racial/ethnic disparities in liver transplantation (LT) are well‐recognized. Although Hispanics represent the largest and youngest minority group in the United States, limited data exist on long‐term outcomes. We aimed to investigate long‐term post‐liver transplant outcomes in Hispanic patients and identify potential disparities compared to a baseline demographic of non‐Hispanic white patients. Methods: We performed a retrospective cohort study of first‐time liver transplant recipients using the United Network for Organ Sharing database from 2002 to 2013, with follow‐up through 2018. The primary outcomes of interest were overall patient and graft survival after LT. Results: 45 767 patients underwent LT (85.0% non‐Hispanic white, 15.0% Hispanic). Hispanics had lower socioeconomic status, higher prevalence of pretransplant comorbidities and more severe liver disease compared to non‐Hispanic whites. Hispanics had similar patient (76.6% vs 75.6%; P = .12) and graft (71.7% vs 70.8%; P = .28) survival at 5 years and significantly better patient (62.9% vs 59.7%; P < .001) and graft (58.6% vs 55.6%; P = .002) survival at 10 years. In multivariable analysis, Hispanics had lower associated all‐cause mortality (HR 0.86, 95% CI, 0.82‐0.91; P < .001) and graft failure (HR 0.89, 95% CI, 0.85‐0.93; P < .001) compared to non‐Hispanic whites. In etiology‐specific subanalysis, Hispanics transplanted for ALD, NASH and HCV had lower all‐cause mortality compared to non‐Hispanic whites. Conclusions: Hispanics have similar or better long‐term post‐LT outcomes compared to non‐Hispanic whites despite a worse pretransplant risk factor profile. Further research is needed to clarify if this survival advantage reflects uncaptured protective factors or more stringent transplant selection in the Hispanic population.