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Race Influences Liver Transplants

WebMD Health News
Reviewed by Gary D. Vogin, MD

Jan. 25, 2002 -- Previous studies have shown that blacks fare worse than other groups after a kidney transplant. Now, researchers have shown the same holds true for liver transplantation. Apparently, blacks, as well as Asians, are significantly more likely than other races to experience organ rejection or to die following the procedure. The reason for this unfortunate discrepancy remains unclear.

Paul Thuluvath, MD, of Johns Hopkins University School of Medicine, and colleagues reviewed records for every liver transplant performed in the United States between 1988 and 1996. The information included age, sex, race, blood type, and cause of death for both donors and recipients.

They found that at both two and five years after the transplantation, survival rates for blacks and Asians were significantly lower than for whites or Hispanics. Blacks and Asians were also more likely to experience transplant rejection. Even after the researchers took all other known risk factors for transplant failure into account, race still stood out as an independent predictor of poor survival for blacks and Asians.

"African Americans and Asians have a worse outcome after liver transplant compared with white Americans and Hispanics," the researchers write.

What is happening here, and what can be done about it?

There are several possible explanations. First, poor matching of blood and genetic variables between liver donors and black recipients may be to blame. Second, "poor socioeconomic status, and lack of insurance benefits resulting in inadequate post-transplant care," could be a factor. Also, there's the potentially important fact that black patients were an average of seven years younger at the time of transplant, and thus sicker than other patients.

The most likely explanation, the researchers write, is "that immunological factors, yet unidentified, might be contributing to chronic rejection. Moreover, most of the currently available [antirejection] drugs were tested in predominantly white Americans and there might be a need to test these drugs more rigorously in minorities."

Given "the higher rate of chronic rejection in African Americans and a relatively worse outcome in other minority races merits further examination," they conclude.

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