Effect of race on outcome of orthotopic liver transplantation: a cohort study

Background There is significant evidence to suggest that long-term survival after renal transplantation is significantly lower in African Americans than In other races. We aimed to establish whether there was a difference in survival in African Americans compared with other races after orthotopic liver transplantation (OLT) and whether race was an independent predictor of survival. Methods We collected data from the United Network of Organ Sharing transplant registry for all liver transplants done between 1988 and 1996 in the USA, We also recorded information on age, sex, race, blood group, and cause of death for the donors and recipients. Findings 2-year graft survival was significantly lower for African Americans (601 of 884, 680) and Asians (266 of 416, 64%) compared with white Americans (8703 of 11762, 74%) and Hispanics (878 of 1220, 72%). 2-year and 5-year patient 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 11762 [83%], 4357 of 7514 [58%]) and Hispanics (964 of 1220 [79%], 341 of 657 [52%]). Compared with white Americans, African American (hazard ratio 1.36, 95% CI 1.16-1.60, p<0.0001) and Asian (1.25, 1.01-1.56, p=0.03) race were independent predictors of poor survival at 2 years. Interpretation African Americans and Asians have a worse outcome after OLT compared with white Americans and Hispanics. The higher rate of chronic rejection in African Americans and a relatively worse outcome in other minority races merits further examination.