1001 Significant Differences in Liver Transplant (LT) Waitlist Mortality, Receiving LT, and Post-LT Survival Among Adults With Primary Sclerosing Cholangitis, Primary Biliary Cholangitis, and Autoimmune Hepatitis in the U.S.

Abstract

INTRODUCTION: Given few studies specifically focusing on waitlist (WL) and liver transplant (LT) outcomes among adults with autoimmune liver diseases, there is a need to better understand epidemiology and outcomes among patients with primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), and autoimmune hepatitis (AIH). We aim to evaluate disparities in LT outcomes among adults with PSC, PBC, and AIH using data from a comprehensive U.S. LT registry. METHODS: We retrospectively evaluated U.S. adults (age ≥18 y) listed for LT using the 2004-2017 United Network for Organ Sharing database, focusing on patients with PSC, PBC, and AIH. Overall WL survival, probability of receiving LT, and post-LT survival were evaluated using Kaplan Meier methods and adjusted multivariate Cox proportional hazards models. RESULTS: Among 11,742 patients listed for LT (34.7 % PSC, 32.9 % PBC 32.2 % AIH), PSC patients had higher proportion of male patients (69.3% vs. 14.3% in PBC and 26.9% in AIH, P < 0.001), and PBC patients were older at time of WL registration (mean age: 46.7 PSC vs. 56.5 PBC vs. 48.1 AIH, P < 0.001). While majority of patients were non-Hispanic white, AIH patients had higher proportion of African Americans, and PBC and AIH had higher proportion of Hispanics compared to PSC. Compared to PSC, those with PBC had lower risk of WL death (HR 0.76, 95% CI 0.63-0.92, P < 0.01). Compared to non-Hispanic whites, Asians had significantly higher risk of WL death (HR 1.61 95% CI 1.05-2.45, P < 0.03). When evaluating probability of receiving LT, AIH patients had lower likelihood of receiving LT compared to PSC (HR 0.82, 95% CI 0.76-0.89, P < 0.001). Hispanics had lower likelihood of LT compared to non-Hispanic whites (HR 0.77, 95% CI 0.70-0.85, P < 0.001). Among LT recipients, AIH patients had significantly higher risk of death post-LT compared to PSC patients (HR 1.29 95% CI 1.09-1.51, P < 0.01). African Americans had significantly higher risk of death post-LT compared to non-Hispanic whites. CONCLUSION: Compared to U.S. adults with PSC listed for LT, PBC patients had significantly lower risk of WL death and AIH patients had significantly lower likelihood of receiving LT. Among patients that underwent LT, AIH patients had significantly higher risk of post-LT death compared to PSC. While the majority of patients were non-Hispanic white, comparatively, Asians had significantly higher risk of WL death and African Americans had significantly higher risk of post-LT death.