title: Recipient-donor race mismatch for African American liver transplant patients with chronic hepatitis C.
abstract: African American (AA) recipient-donor race mismatch has been associated with graft loss and mortality, but studies of an association between race mismatch and hepatitis C virus (HCV) disease severity are lacking. HCV-infected adults from 4 US centers who underwent liver transplantation for the first time (n = 1093) were followed for a median of 3.05 years to determine the rates of advanced HCV disease (bridging fibrosis or cirrhosis) and graft failure; 11% of the patients were AA. The unadjusted cumulative rate of advanced fibrosis was higher in AAs than non-AAs (56% and 40% at 4 years, respectively, (P < 0.01), and 59% and 56% for AA recipient-donor-matched patients and AA recipient-donor-mismatched patients, respectively (P = 0.89). In adjusted models, both AA recipient race [hazard ratio (HR) = 1.47, 95% CI = 1.06-2.03, P = 0.02] and AA recipient-donor mismatch (versus match; HR = 1.48, 95% CI = 1.03-2.12, P = 0.03) were significant predictors of advanced fibrosis; other independent predictors were donor age (HR = 1.21, P < 0.01) and cytomegalovirus infection (HR = 1.55, P < 0.01). The 4-year unadjusted cumulative rates for HCV-associated graft loss were 10% and 17% for non-AAs and AAs, respectively (P < 0.01), and 0% and 21% for AA recipient-donor-matched patients and AA recipient-donor-mismatched patients, respectively (P < 0.01). In adjusted models, AA recipient-donor-mismatched patients had a 62% higher rate of graft loss than non-AA recipients (HR = 1.62, 95% CI = 1.14-2.29, P < 0.01), and AA recipient-donor-matched patients had a 76% lower rate of graft loss/mortality (HR = 0.24, 95% CI = 0.06-0.97, P = 0.05). In conclusion, AA recipient-donor-mismatched patients who are infected with HCV are at high risk for advanced HCV disease and HCV-related graft loss and constitute a patient group that will benefit from new therapeutic strategies for preventing graft loss.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0538, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Saxena
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lai
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Kartik
authors.initials: K
authors.lastname: Krishnan
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D001741:Black or African American; D005260:Female; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000208:ethnology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D016031:Liver Transplantation / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors