Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California.
Department of Transplant Surgery, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
Clin Gastroenterol Hepatol. 2018 Jun;16(6):965-973.e2. doi: 10.1016/j.cgh.2017.12.017. Epub 2018 Feb 8.
BACKGROUND & AIMS: Data on the differences in ethnicity and race among patients with primary biliary cholangitis (PBC) awaiting liver transplantation (LT) are limited. We evaluated liver transplant waitlist trends and outcomes based on ethnicity and race in patients with PBC in the United States.
Using the United Network for Organ Sharing (UNOS) registry, we collected data on patients with PBC on the liver transplant waitlist, and performed analysis with a focus on ethnicity and race-based variations clinical manifestations, waitlist mortality and LT rates from 2000 to 2014. Outcomes were adjusted for demographics, complications of portal hypertension, and Model for End-stage Liver Disease score at time of waitlist registration.
Although the number of white PBC waitlist registrants and additions decreased from 2000 to 2014, there were no significant changes in the number of Hispanic PBC waitlist registrants and additions each year. The proportion of Hispanic patients with PBC on the liver transplant waitlist increased from 10.7% in 2000 to 19.3% in 2014. Hispanics had the highest percentage of waitlist deaths (20.8%) of any ethnicity or race evaluated. After adjusting for demographic and clinical characteristics, Hispanic patients with PBC had the lowest overall rate for undergoing LT (adjusted hazard ratio, 0.71; 95% CI, 0. 60-0.83; P < .001) and a significantly higher risk of death while on the waitlist, compared to whites (adjusted hazard ratio, 1.41; 95% CI, 1.15-1.74; P < .001). Furthermore, Hispanic patients with PBC had the highest proportion of waitlist removals due to clinical deterioration.
In an analysis of data from UNOS registry focusing on outcomes, we observed differences in rates of LT and liver transplant waitlist mortality of Hispanic patients compared with white patients with PBC. Further studies are needed to improve our understanding of ethnicity and race-based differences in progression of PBC.
原发性胆汁性胆管炎（PBC）患者在等待肝移植（LT）时，其种族和民族差异的数据有限。我们评估了美国 PBC 患者基于种族和民族的肝移植等待名单趋势和结果。
我们使用器官共享联合网络（UNOS）登记处收集了 PBC 患者的肝移植等待名单数据，并重点分析了 2000 年至 2014 年期间种族和民族差异的临床表现、等待名单死亡率和 LT 率。结果通过人口统计学、门静脉高压并发症和等待名单登记时终末期肝病模型评分进行了调整。
尽管白人 PBC 等待名单注册者和新增者的数量从 2000 年到 2014 年有所减少，但每年新增的西班牙裔 PBC 等待名单注册者和新增者数量没有显著变化。2014 年西班牙裔 PBC 患者在肝移植等待名单中的比例从 2000 年的 10.7%增加到 19.3%。在评估的任何种族或民族中，西班牙裔患者的等待名单死亡率（20.8%）最高。调整人口统计学和临床特征后，与白人相比，PBC 的西班牙裔患者 LT 的总体发生率最低（调整后的危险比，0.71；95%可信区间，0.60-0.83；P<0.001），等待名单上的死亡风险显著更高（调整后的危险比，1.41；95%可信区间，1.15-1.74；P<0.001）。此外，PBC 的西班牙裔患者因临床恶化而被取消等待名单的比例最高。
在对 UNOS 登记处的数据进行以结果为重点的分析中，我们观察到与白人 PBC 患者相比，西班牙裔患者的 LT 率和肝移植等待名单死亡率存在差异。需要进一步研究以提高我们对 PBC 进展中种族和民族差异的理解。
