Black Patients with Cirrhosis Have Worse Liver-Related Outcomes: A Large Multicenter Study
1Gastroenterology and Hepatology, Northwestern University, Chicago, IL, 2Department of Surgery, Tulane Abdominal Transplant Institute, New Orleans, LA, 3Center for Health Information Partnerships, Northwestern University, Chicago, IL, 4Transplant Surgery, Northwestern University, Chicago, IL, 5Feinberg School of Medicine, Northwestern University, Chicago, IL
Meeting: 2020 American Transplant Congress
Abstract number: 484
Keywords: African-American, Liver cirrhosis, Liver transplantation, Waiting lists
Session Information
Session Name: All Organs: Disparities to Outcome and Access to Healthcare II
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:15pm-3:27pm
Location: Virtual
*Purpose: Racial disparity is influential in liver cirrhosis. Estimates of its magnitude have been limited by lack of large, longitudinal data that track patients from diagnosis to death or transplant.
*Methods: A population based cohort of the greater Chicago area (HealthLNK) containing de-duplicated electronic health record data from seven large health systems was linked to the state death registry and the national transplant database (UNOS). Patients with a diagnosis code of cirrhosis and at least one MELD-Na measurement during 2006-2012 were included. Multivariate competing risk analysis used an outcome of either all-cause mortality or liver-related death as defined by blinded death certificate review.
*Results: 10,535 patients met inclusion criteria of whom 2,237 (21.2%) identified as Black. Compared to White patients, Black patients had similar demographics with a mean age of 56, 43.6% female, average peak MELD-Na score of 18, and proportion of alcohol related liver disease 42%. Black patients had higher comorbidity burden (Elixhauser score 7.0 vs 5.8, p<0.001), lower rates of private insurance (20% vs 38% p<0.001) and lower rates of portal hypertensive complications (49.4% vs 60%, p<0.001). Compared to White patients, Black patients were less likely to be listed for liver transplantation (6% vs 25% p<0.001). Black patients had the highest incidence of all-cause mortality and non-liver related death, as well as the lowest incidence of transplant(Figure). Compared to White patients, in multivariate analysis adjusted for gender, age, insurance status, Elixhauser score, etiology of cirrhosis, presence of portal hypertensive complication, and peak MELD-Na black patients had a 52% increased hazard of all-cause mortality (transplantation as a competing risk; sHR 1.52, 95% CI [1.38-1.67], p<0.001) and a 33% increased hazard of liver-related death (transplantation and non-liver related death as competing risks; sHR 1.33 95% CI[1.19-1.50], p<0.001).
*Conclusions: Even after adjustment for a higher burden of non-liver related comorbidities, black patients with cirrhosis are more likely to suffer liver related death and are less likely to be listed or transplanted. Further research should determine how to address these real disparities.
To cite this abstract in AMA style:
Mazumder NR, Atiemo K, Jackson K, Daud A, Kho A, Gabra LG, Levitsky J, Ladner DP. Black Patients with Cirrhosis Have Worse Liver-Related Outcomes: A Large Multicenter Study [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/black-patients-with-cirrhosis-have-worse-liver-related-outcomes-a-large-multicenter-study/. Accessed May 10, 2025.« Back to 2020 American Transplant Congress