Primary Sclerosing Cholangitis Is a More Common Indication for Orthotopic Liver Transplantation among African American Than Non-African American Patients

Abstract

Purpose: Primary sclerosing cholangitis (PSC) is a progressive, incurable condition of unknown etiology, characterized by inflammation, fibrosis, destruction and loss of interlobular-sized bile ducts, leading to biliary cirrhosis and liver failure. Orthotopic liver transplantation (OLT) is the only life-extending intervention for patients with end-stage PSC. Recent US Scientific Registry of Transplant Recipients (SRTR) data indicate that among patients with PSC being added to the United Network for Organ Sharing (UNOS) waiting list the proportion of African Americans (AA) was greater than non-AAs, compared to other disease indications. This suggests that PSC may run a more aggressive clinical course. It was our aim to determine whether the proportion of AA patients with PSC undergoing OLT per unit time was different from the proportion of non-AA patients undergoing OLT for PSC. Methods: The SRTR was reviewed between 1998 and 2002 inclusive for all adults (18 – 80 years) who were added to the UNOS waiting list for OLT. The proportions of AA and non-AA patients undergoing OLT for PSC within 1 year, 1–2 years, 2–3 years, and > 3 years of being added to the waiting list were calculated, and compared using the Chi-square test. Results: From 1998 to 2002 inclusive 39,878 patients were added to the UNOS waiting list for OLT. 2173 (5.45%) had PSC. Of these, 262 (12.1%) were AA. The proportions of AA patients with PSC who underwent OLT within 1 year, 1–2 years, 2–3 years, and >3 years of being added to the waiting list were: 28.2% (74/262), 13.7% (36/262), 8.8% (23/262) and 5.7% (15/262). 114/262 (43.5%) AA patients with PSC did not undergo OLT during the study period. The proportions of non-AA patients with PSC who underwent OLT within 1 year, 1–2 years, 2–3 years, and > 3 years of being added to the waiting list were: 33.5% (640/1911), 11.5% (220/1911), 4.7% (89/1911) and 4.9% (93/1911). 869/1911 (45.5) non-AA patients with PSC did not undergo OLT during this period. Except for the period < 1 year from the time of OLT listing, the proportion of AA patients with PSC undergoing OLT was significantly greater than the porportion of non-AA patients with PSC who underwent OLT (P= 0.026). Conclusion: These outcomes for AA patients with PSC suggest that their disease course may be more agressive, given that patients underwent OLT sooner from the time of listing than did non-AA patients. An alternative explanation is that AA patients with PSC were simply sicker than non-AA patients at the time of listing for OLT.