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Black patients with ALF more likely listed for liver transplant as status-1

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PHILADELPHIA – Black patients were more likely to be waitlisted with acute liver failure, require status-1 listing and undergo liver transplantation than white patients, according to a presentation at the American College of Gastroenterology Annual Meeting.

“Acute liver failure is a potentially fatal condition characterized by severe hepatic injury resulting in liver dysfunction and encephalopathy,” Lauren D. Nephew, MD, MSCE, from Indiana University, said during her presentation. “Our aim was to explore differences in clinical characteristics and etiologies of ALF between black and white patients waitlisted for LT.”

To compare racial differences in liver disease and receipt of curative therapies, Nephew and colleagues reviewed outcomes of patients waitlisted between 2002 and 2016 with a primary diagnosis of ALF.

Of those 5,161 patients listed with a primary diagnosis of ALF, patients were more often black (7.6% vs. 3.8%; P < .001) and black patients were more likely to be listed as status-1 than white patients (54.5% vs. 43.4%; P < .001).

Black patients also had worse coagulopathy (5.4 vs. 4.8 international normalized ratio; P = .001) and higher bilirubin at presentation (19.5 mg/dL vs. 12.2 mg/dL; P < .001) than white patients.

While the researchers found no significant racial difference in waitlist removal due to sickness or mortality, black patients were significantly more likely to undergo liver transplantation than white patients (HR = 1.19; 95% CI, 1.06-1.32).

“Higher bilirubin in black compared to white patients accounted for higher rates of LT,” Nephew highlighted in her conclusion. “Future studies should explore if more acute liver disease at presentation in black patients is due to late referral or inherently worse liver disease.” – by Talitha Bennett

Reference : Nephew L, et al. Abstract 59. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Nephew reports no relevant financial disclosures.