Adult African Americans undergoing cadaveric liver transplantation for hepatocellular carcinoma within the Milan criteria have the lowest 5-year survival among all the ethnic groups in the United States: analysis of USA national data between January 2002 and June 2013

Abstract

Aim: To investigate the potential effects of recipient ethnicity on the short and long-term outcomes of patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) in the United States. We performed a retrospective study using the standard transplant analysis and research (STAR) files with the primary aim of assessing short and long-term survival of different ethnic groups undergoing LT for HCC in the United States.

Methods: The study population was represented by adults (age ≥ 18) who received a first-time cadaveric LT for HCC between 1 Jan 2002 and 30 Jun 2013. Recipients of LT for other primary and secondary malignancies were excluded. Other exclusion criteria were: transplants from grafts recovered from living or donors after cardiac death, split grafts, multi-visceral or redo transplants, and LT performed across ABO incompatible blood groups. Survival analysis stratified by recipient ethnicity was performed using the Kaplan-Meier method. Proportional hazard model analysis was used to assess the effect of predictors of survival. Characteristics utilized in the Cox regression model were selected a priori.

Results: The study population was represented by 6048 recipients with an average age of 58 years and 20% being females. The majority of patients were Caucasians (67%), followed by Hispanics (14.2%), African Americans (8.8%) and Asians (8.6%). Overall 30-, 60-, 90-day and 1-year mortality was 1.7%, 2.3%, 3.0% and 8.8% respectively with no statistically significant differences among ethnicities. Log-rank comparisons however showed that African American had the lowest 5-year survival with statistically significant differences in comparison to all other ethnic groups (P ≤ 0.001). At multivariate Cox-regression analysis, African American ethnicity remained an independent predictor for increased mortality (HR = 1.524; 95% CI: 1.283-1.803; P < 0.001) after adjusting for the recipient and donor age, recipient sex, recipient history of diabetes and recipient functional status at the time of transplantation.

Conclusion: Short-term outcomes of African Americans undergoing cadaveric LT for HCC are similar to other ethnic groups. However, African American ethnicity is an independent predictor of lower 5-year overall survival when compared to all other ethnic groups.

Keywords

Hepatocellular carcinoma / ethnicity / survival / Cox-regression / liver transplantation / predictor

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