Role of Donor Race in Liver Transplant Outcomes in African American Patients With Hepatocellular Carcinoma
Among African American adults undergoing liver transplant to treat hepatocellular carcinoma, patients whose organ donor was also African American lived significantly longer than those with a racially unmatched donor, report authors of a new study using national data. Their findings were published by Silva et al in the Journal of the American College of Surgeons.
These research findings suggest a possible way to improve long-term survival in a patient population that typically fares worse than other racial groups with liver cancer. Compared with other races, African American patients with hepatocellular carcinoma tend to have the poorest long-term survival and have worse outcomes after liver transplant, according to findings published by Artinyan et al in Cancer. A liver transplant is the preferred and curative treatment option for some patients with early-stage hepatocellular carcinoma, according to the study authors.
Study Methods
Although past studies have linked unmatched donor-recipient race to worse overall survival in recipients of kidney, lung, and heart transplants, the role of donor race in liver transplantation has not been well-defined, explained principal investigator T. Clark Gamblin, MD, MS, MBA, FACS, Professor and Chief of Surgical Oncology at the Medical College of Wisconsin, Milwaukee.
For this study, Dr. Gamblin and colleagues used the Organ Procurement and Transplantation Network’s (OPTN’s) national database. The researchers identified 15,141 adults with first-time hepatocellular carcinoma who received a transplant of a whole liver from a deceased donor between 1994 and 2015. Of those transplant recipients, 1,384 (9.1%) were African American, and their records were further analyzed for the donor’s race. A total of 325 patients (23.5%) received livers from African American donors—labeled “matched”—and the other 1,059 patients (76.5%) received livers from unmatched donors.
Study Results
Five years after transplant, 64.2% of patients with matched donor-recipient race were still alive, compared with 56.9% of patients with unmatched donor-recipient race. On average, patients with matched donor-recipient race lived 4.75 years longer after transplant than the unmatched patients, with a median overall survival of 135 months vs 78 months.
This effect of donor race continued even after the researchers statistically matched the two groups on multiple donor and recipient characteristics that are important to transplant success and patient survival. On these adjusted analyses, matched donor-recipient race independently predicted improved overall survival, the investigators reported.
Specifically, African American transplant recipients had 34% greater odds of long-term survival when the donor’s race was the same. African Americans who received a liver from a white donor—the most common race among donors—had a reported 53% increased risk of death. The survival advantage with matched donor-recipient race reportedly did not become apparent until after 1 year.
“Our data are intriguing,” said Dr. Gamblin. “But our results require validation through further investigation of the role of race in optimizing outcomes of liver transplant for treatment of [hepatocellular carcinoma].”
“It is certainly premature to recommend a change in compatibility screening criteria based on our findings alone,” continued Dr. Gamblin, who noted that race is not currently a consideration during compatibility screening of donors for liver transplant.
Less than one-fourth of the African American liver transplant recipients in this study had matched donor-recipient race, which corresponds to national statistics showing low organ donation rates by African Americans. Although 29.8% of all U.S. candidates waiting for an organ transplant are African American, only 13.5% of all organ donors in 2015 were African American, according to statistics from the U.S. Department of Health and Human Services Office of Minority Health.
Disclosure: The study authors’ full disclosures can be found at journalacs.org.
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