Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, CA.
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA.
Am J Transplant. 2021 Dec;21(12):3883-3893. doi: 10.1111/ajt.16767. Epub 2021 Aug 10.
A landmark 2002 study identified Black liver transplant (LT) recipients as having lower post-LT survival compared to other races. While persistent disparities exist, changes over time and mediating factors are understudied. Capturing LT recipients between 2002 and 2018 in UNOS, we used logistic regression and Cox proportional-hazard models to calculate differences in post-LT mortality among races. We examined interactions between transplant year and race. A mediation analysis assessed biologic and environmental factors potentially associated with race differences in post-LT survival. The cohort included 46,997 LT recipients (3898 Black;36,560 White;6539 Hispanic). In most years, Black (vs. White) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics. In multivariable analysis, Blacks (vs. Whites) had higher (aHR = 1.15, 95% CI 1.07-1.24), whereas Hispanics had lower (aHR = 0.78, 95% CI 0.72-0.83) risk of mortality. Differences in post-LT mortality among Blacks (vs. Whites) narrowed between 2002 and 2009, were similar between 2010 and 2013, and may have worsened between 2014 and 2018. Race differences were larger for mortality beyond 1-year post-LT (vs. within 1-year), and among non-HCV (vs. HCV). Alcohol-associated liver disease (ALD) was the strongest mediator (13.9%, 95% CI 8.7-32.7%) of the Black-White disparity in 2010-2018. Our analyses suggest disparities may worsen with longer follow-up, as HCV recedes with elimination efforts, and with further increases in ALD.
一项具有里程碑意义的 2002 年研究表明，与其他种族相比，黑种人肝移植（LT）受者的 LT 后生存率较低。尽管持续存在差异，但随着时间的推移和中介因素的变化仍有待研究。我们在 UNOS 中收集了 2002 年至 2018 年间的 LT 受者，使用逻辑回归和 Cox 比例风险模型来计算不同种族之间 LT 后死亡率的差异。我们检查了移植年份与种族之间的相互作用。中介分析评估了可能与 LT 后生存率种族差异相关的生物学和环境因素。该队列包括 46997 名 LT 受者（3898 名黑人；36560 名白人；6539 名西班牙裔）。在大多数年份，黑人（与白人相比）LT 受者的年龄调整死亡率更高，而西班牙裔则没有观察到这种情况。在多变量分析中，黑人（与白人相比）的死亡率更高（aHR=1.15，95%CI1.07-1.24），而西班牙裔的死亡率则更低（aHR=0.78，95%CI0.72-0.83）。黑人（与白人相比）LT 后死亡率的差异在 2002 年至 2009 年期间缩小，在 2010 年至 2013 年期间相似，在 2014 年至 2018 年期间可能恶化。LT 后 1 年以上（与 1 年内）以及非 HCV（与 HCV）的死亡率差异更大。酒精性肝病（ALD）是 2010-2018 年黑人和白人之间差异的最强中介因素（13.9%，95%CI8.7-32.7%）。我们的分析表明，随着 HCV 随着消除工作的推进而消退，以及随着 ALD 的进一步增加，随着时间的推移，差异可能会恶化。
