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WASHINGTON -- Among patients with alcoholic liver disease (ALD), Hispanics were less likely to receive liver transplants, while blacks were more likely to die after transplant, researchers reported here.
In a , Hispanics were significantly less likely to get a liver transplant (LT) when compared with non-Hispanic whites (HR 0.74, 95% CI 0.70-0.79, P<0.001), according to Robert J. Wong, MD, of Alameda Health System-Highland Hospital in Oakland, California, and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Also compared with non-Hispanic whites, African Americans were more likely to die after transplant (HR 1.29, 95% CI 1.04-1.60, P=0.01), but they were less likely to die while on the transplant waitlist (HR 0.74, 95% CI 0.57-0.95, P=0.02), Wong said in a presentation at Digestive Disease Week.
"The trends haven't changed much. Disparities still exist despite our attempts to raise awareness," Wong told MedPage Today.
Wong's group analyzed data from U.S. adults with ALD listed for transplant in the 2005-2016 LT registry. They sought "to evaluate overall rates and predictors of waitlist mortality, probability of receiving LT, and post-LT survival among U.S. adults with ALD awaiting LT, with a focus on race/ethnicity-specific disparities."
Among the 22,385 patients studied, 75.6% were male, 77.9% were non-Hispanic white, and 17% Hispanic. The mean age was 54.2, and 8.9% had hepatocellular carcinoma (HCC). The overall probability of 90-day waitlist survival was 59% (95% CI 57-60), while 90-day likelihood of receiving transplant was 32% (95% CI 31-33), and 5-year post-transplant survival was 77% (95% CI 76-78).
The researchers found that ALD patients with concurrent HCC had significantly higher waitlist mortality (HR 1.79, 95% CI 1.45-2.22, P<0.001). Also, ALD patients with HCC were significantly more likely to receive transplant versus those without HCC (HR 2.32, 95% CI 2.16-2.50, P<0.001).
Finally, men with ALD were significantly more likely to receive transplant than women (HR 1.19, 95% CI 1.13- 1.25, P<0.001).
The finding regarding Hispanics follows an earlier study that Wong co-authored, showing that Hispanics were less likely to get treated for (HCV). That study examined nearly 30,000 chronic HCV patients across four health care systems. A by Wong and colleagues found Hispanics were less likely to get a liver transplant among a population of 43,478 chronic HCV patients listed for transplant.
The finding regarding black mortality rates was consistent with a published, which found blacks "had the lowest overall and etiology-specific five-(year) post-LT survival" among patients with HCV, HCC, ALD, non-alcoholic steatohepatitis, and cryptogenic cirrhosis. They also exhibited the "lowest post-LT survival among patients with HCV, HCC, and ALD."
Wong said his group is collecting data from single-center and multiple-center health systems to look for detailed answers explaining these trends, as analyzing national databases can only show so much.
"Transplant should be an equitable process. We want to highlight the disparities," he stated.
Primary Source
Digestive Disease Week
Kaswala DH, et al "Race/ethnicity-specific disparities in waitlist mortality, probably of receiving liver transplantation, and post transplant survival among U.S. adults with alcoholic liver disease" DDW 2018; Abstract SA1462.