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Effect of Donor Race-Matching on Overall Survival for African-American Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma. J Am Coll Surg 2019 03;228(3):245-254

Date

01/15/2019

Pubmed ID

30639515

DOI

10.1016/j.jamcollsurg.2018.11.016

Scopus ID

2-s2.0-85060157296   2 Citations

Abstract

BACKGROUND: Liver transplantation (LT) is the preferred treatment for early hepatocellular carcinoma (HCC) in select patients. Differences in outcomes after LT have been previously described between recipient races, but the role of donor race is not well defined. This study sought to examine the effect of donor-recipient race-matching on overall survival after liver transplantation for HCC in African-American patients (AA).

STUDY DESIGN: Adult AA patients with HCC undergoing liver transplantation were identified using the Organ Procurement and Transplantation Network database (1994 to 2015). Recipient and donor demographic and clinical characteristics were collected. Patients were separated into unadjusted cohorts based on whether the liver donor was AA (matched) or another race (unmatched). The primary outcome was overall survival, which was analyzed by log-rank test and graphed using the Kaplan-Meier method. Multivariate regression modeling was used to determine adjusted hazard ratios (HR) for overall survival.

RESULTS: Of 1,384 AA patients identified, 325 (23.5%) were race-matched. Matched patients experienced significantly better median overall survival when compared with the unmatched cohort (135 vs 78 months, p = 0.007). Multivariate analysis revealed an adjusted hazard ratio of 0.66 for race-matched transplantation (95% CI 0.49 to 0.88; p = 0.004). Matched patients also experienced an improved 5-year survival (64.2% vs 56.9%; p = 0.019).

CONCLUSIONS: African-American HCC patients undergoing liver transplantation experienced significantly improved overall survival when the donor race matched the recipient race. Donor-recipient race-matching remained an independent predictor of improved survival after adjusting for comorbidities and disease characteristics. Race-matching should be considered in the process of organ allocation because it may affect long-term survival in African-American HCC patients.

Author List

Silva JP, Maurina MN, Tsai S, Christians KK, Clarke CN, Mogal H, Saeian K, Gamblin TC

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Harveshp Mogal MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Susan Tsai MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
African Americans
Carcinoma, Hepatocellular
Donor Selection
Female
Graft Survival
Humans
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Retrospective Studies
Survival Rate
Treatment Outcome
jenkins-FCD Prod-468 69a93cef3257f26b866d455c1d2b2d0f28382f14