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Mortality post-transplant higher in young blacks with PSC vs. whites

LAS VEGAS — Young black adults with primary sclerosing cholangitis have higher wait-list and post-liver transplant mortality compared with white adults and older patients, per data presented at ACG 2016.

“Few studies have examined racial differences in wait-list and transplant outcomes in patients with PSC,” Julius Wilder, MD, PhD, medical instructor at Duke University, said during a liver plenary session. “When we look back on the limited data that do exist, there are a few patterns that we see. There are interactions between age, race, particularly among African Americans. … In the setting of this, we wanted to characterize the differences in phenotype and outcomes of African Americans and white patients with PSC listed for transplant based on age.”

Wilder and colleagues evaluated adults listed for primary LT with PSC between April 1994 and June 2015 from the United Network for Organ Sharing (UNOS) database and divided them into three groups based on age: 18 to 39 years (young), 40 to 59 years (middle-aged) and over 60 years (older). Of 7,788 patients, 6,750 were white (86.2%) and 1,038 (13.3%) were black. Only 6% of black patients were aged older than 60 years.

“We divided them so we could begin to understand the role of age,” Wilder said.

Through Cox proportional regression models, the researchers found that young black adults had higher wait-list mortality (adjusted HR = 1.91; 95% CI, 1.22-2.97) and were least likely to be de-listed due to an improvement in their condition (1.7%) compared with young white adults (3.8%; P = .022).

Young black patients experienced more acute rejection post-transplant compared with white patients (38.8% vs. 27.9%; P = .002) and had a higher risk for graft failure (aHR = 1.33; 95% CI, 1.08-1.64). They were also least likely to undergo re-transplantation after graft failure (44.1% vs. 60.5%; P = .002) and had a higher 5-year post-LT mortality rate (aHR = 2.11; 95% CI, 1.44-3.09).

Wilder acknowledged limitations of the study, stating during his presentation that overall, small cohorts were used when broken down by age group, the data were limited by variables and data available in the UNOS database.

He concluded: “Results suggest an interaction between race and age that predicts a more aggressive PSC phenotype with worse outcomes following liver transplant. Future research should identify root causes for these racial health disparities in PSC.” – by Melinda Stevens

Reference:

Wilder JM, et al. Abstract #49. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.

Disclosure: The researchers report no relevant financial disclosures.