Racial and ethnic disparities in post‐liver transplant outcomes for patients with acute‐on‐chronic liver failure: An analysis of the UNOS database

Author:

Lee David Uihwan1ORCID,Shaik Mohammed Rifat1,Bhowmick Kuntal2,Fan Gregory Hongyuan3,Schuster Kimberly3,Yousaf Abdul4,Refaat Mohamed4,Shaik Nishat Anjum5,Lee Ki Jung3,Yang Sarah1,Bahadur Aneesh3,Urrunaga Nathalie H.1

Affiliation:

1. Division of Gastroenterology and Hepatology University of Maryland School of Medicine Baltimore Maryland USA

2. Department of Medicine Warren Alpert Medical School of Brown University Providence Rhode Island USA

3. Liver Center, Division of Gastroenterology, Tufts Medical Center Boston Massachusetts USA

4. University of Missouri Kansas City School of Medicine Kansas City Missouri USA

5. Department of Medicine Saint Louis University Saint Louis Missouri USA

Abstract

SummaryBackgroundThe incidence of hospitalisations related to acute‐on‐chronic liver failure (ACLF) is increasing. Liver transplantation (LT) remains the definitive treatment for the condition.AimTo evaluate the influence of race and ethnicity on LT outcomes in ACLF.MethodsWe conducted a retrospective analysis utilising LT data from the United Network for Organ Sharing (UNOS) database. White patients served as the control group and patients of other races were compared at each ACLF grade. The primary outcomes assessed were graft failure and all‐cause mortality.ResultsBlacks exhibited a higher all‐cause mortality (Grade 1: aHR 1.36, 95% CI 1.18–1.57, p < 0.001; Grade 2: aHR 1.27, 95% CI 1.08–1.48, p = 0.003; Grade 3: aHR 1.19, 95% CI 1.04–1.37, p = 0.01) and graft failure (Grade 1: aHR 2.05, 95% CI 1.58–2.67, p < 0.001; Grade 2: aHR 1.91, 95% CI 1.43–2.54, p < 0.001; Grade 3: aHR 1.50, 95% CI 1.15–1.96, p = 0.002). Hispanics experienced a lower all‐cause mortality at grades 1 and 3 (Grade 1: aHR 0.83, 95% CI 0.72–0.96, p = 0.01; Grade 3: aHR 0.80, 95% CI 0.70–0.91, p < 0.001) and Asians with severe ACLF demonstrated decreased all‐cause mortality (Grade 3: aHR 0.55, 95% CI 0.42–0.73, p < 0.001).ConclusionBlack patients experienced the poorest outcomes and Hispanic and Asian patients demonstrated more favourable outcomes compared to Whites.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Wiley

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