Independent effect of black recipient race on short-term outcomes after liver transplantation

Abstract

Previous studies have demonstrated worse graft and patient survival for black patients after liver transplantation (LT), but these studies have not accounted properly for recipient, donor, center, or geographic effects. In this study, we evaluated the effect of candidate race on patient and graft survival after LT. Using a novel linkage of the databases of the University Health System Consortium and the US Census and Scientific Registry of Transplant Recipients, we identified 12,445 patients (43.1% of total) who underwent LT in the United States from 2007 to 2011. Using a mixed-effects, proportional hazards model, we assessed the effect of race on patient and graft survival after controlling for recipient, donor, and center characteristics; region; donor service area; and individual transplant centers. At the time of transplantation, white patients were healthier, had a shorter duration of hospital stay, and a lesser in-hospital mortality compared with black and Hispanic patients. White recipients had a graft and patient survival advantage when compared with blacks, but there was no survival difference observed when compared with Hispanics. After controlling for recipient and donor characteristics, geographic region, donor service area, and the effect of the individual hospital, black recipients were still at an increased risk of both death (hazard ratio [HR], 1.31; 95% CI, 1.15-1.50) and graft failure (HR, 1.28; 95% CI, 1.14-1.44) after LT. After controlling for many of the important variables in the transplant process, including the individual hospital, black recipients were at increased risk of both death and graft failure after LT when compared with whites.