Race could influence outcome after liver transplantation

January 24, 2002

N.B. Please note that if you are outside North America the embargo date for Lancet Press material is 0001 hours UK time Friday 25th January 2002.

Outcome after liver transplantation--both in terms of graft rejection and patients survival--could be related to race, with African American and Asian patients faring less well than white Americans and Hispanic patients, conclude authors of a study in this week's issue of THE LANCET.

Evidence from previous research suggests that long-term survival after kidney transplantation is substantially lower in African Americans than in other races. Paul Thuluvath and colleagues from Johns Hopkins University, Baltimore, USA, aimed to establish whether there was a difference in survival in African Americans compared with other races after liver transplantation, and whether race was an independent predictor of survival.

The investigators collected data from the United Network of Organ Sharing transplant registry for all liver transplants done between 1988 and 1996 in the USA. Information on age, sex, race, blood group, and cause of death for the donors and recipients was recorded.

The rate of graft failure due to chronic rejection was almost twice as high among African Americans compared to other races. Two-year graft survival was significantly lower for African Americans (601 of 884, 68%) and Asians (266 of 416, 64%) compared with white Americans (8703 of 11 762, 74%) and Hispanics (878 of 1220, 72%). Patients' two-year and five-year survival were significantly lower for African Americans (654 of 884 [74%], 270 of 565 [48%]) and Asians (287 of 416 [69%], 92 of 252 [37%]) compared with white Americans (9786 of 11 762 [83%], 4357 of 7514 [58%]) and Hispanics (964 of 1220 [79%], 341 of 657 [52%]). Race was an independent predictor of poor two-year survival, with African Americans and Asian patients having an increased risk profile of 36% and 25%, respectively, when compared with white Americans.

Paul Thuluvath comments: "Our study suggests that there is a clear need for prospective studies to examine our observations further. Until then, the reasons for poor survival in African Americans will remain speculative and will probably be dismissed as being due to poor compliance with therapy. Moreover, the higher rate of chronic rejection in African Americans suggests that there should be more rigorous drug trials in this patient population."
Contact: Dr Paul Thuluvath, Division of Gastroenterology, Johns Hopkins University, Room 429, 1830 Building 1830 E Monument Street, Baltimore MD 21205, USA; T) +1 410 614 5389; F) +1 410 614 9612; E) pjthuluv@welchlink.welch.jhu.edu


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