The effect of donor race-matching on overall survival for african american patients undergoing liver transplantation for hepatocellular carcinoma

Abstract

Introduction: Liver transplantation (LT) is the preferred treatment for early hepatocellular carcinoma (HCC) in select patients. Differences in outcomes following LT has been previously described between recipient races, but the role of donor race is not well-defined. This study sought to examine the effect of donor-recipient race-matching on overall survival following liver transplantation for HCC in African Americans (AA). Methods: Adult AA patients with HCC undergoing liver transplantation were identified using the Organ Procurement and Transplantation Network database (1994-2015). Recipient and donor demographic and clinical characteristics were collected. Patients were separated into unadjusted cohorts based on whether the liver donor was AA (matched) or another race (unmatched). The primary outcome was overall survival (OS), which was analyzed by log-rank test and graphed using Kaplan-Meier method. Multivariate regression modeling was used to determine adjusted hazard ratios (HR) for OS. Results: Of 1,384 AA patients identified, 325 (23.5%) were race-matched. Matched patients experienced significantly better median overall survival compared to the unmatched cohort (135 vs. 78 months, p=0.007). Multivariate analysis revealed an adjusted hazard ratio of 0.66 for race-matched transplantation (95% CI: 0.49-0.88; p=0.004). Matched patients also experienced improved five-year survival (64.2% vs. 56.9%; p=0.019). Conclusion: African American HCC patients undergoing liver transplantation experienced significantly improved overall survival when the donor race matched the recipient race. Donor-recipient race-matching remained an independent predictor of improved survival after adjusting for comorbidities and disease characteristics. Race-matching should be considered in the process of organ allocation, as it may impact long-term survival in African Americans.