title: Effects of ethnicity and socioeconomic status on survival and severity of fibrosis in liver transplant recipients with hepatitis C virus.
abstract: The ethnicity and socioeconomic status of the host may affect the progression of hepatitis C virus (HCV). We aimed to compare survival and fibrosis progression in Hispanic white (HW) and non-Hispanic white (NHW) recipients of liver transplantation (LT) with HCV. All HW and NHW patients with HCV who underwent transplantation between January 2000 and December 2007 at 2 centers were retrospectively assessed. The primary outcomes were the time to death, death or graft loss due to HCV, and significant fibrosis [at least stage 2 of 4]. Five hundred eleven patients were studied (159 HW patients and 352 NHW patients), and the baseline demographics were similar for the 2 groups. NHW patients were more likely to be male, to have attended college, and to have private insurance, and they had a higher median household income (MHI). The unadjusted rates of survival (log-rank P = 0.93), death or graft loss due to HCV (P = 0.89), and significant fibrosis (P = 0.95) were similar between groups. In a multivariate analysis controlling for center, age [hazard ratio (HR) per 10 years = 1.43, P = 0.01], donor age (HR per 10 years = 1.25, P < 0.001), and rejection (HR = 1.47, P = 0.048) predicted death, whereas HW ethnicity (HR = 1.06, P = 0.77) was not significant. Independent predictors of significant fibrosis were HW ethnicity (HR = 2.42, P = 0.046), MHI (HR per $10,000 = 1.11, P = 0.01), donor age (HR per 10 years = 1.13, P = 0.02), cold ischemia time (HR = 1.06, P = 0.03), and the interaction between ethnicity and MHI (HR = 0.82, P = 0.03). In conclusion, there is no difference in post-LT survival or graft loss due to HCV between HW patients and NHW patients. Socioeconomic factors may influence disease severity; this is suggested by our findings of more significant fibrosis in HW patients with a low MHI.
authors.affiliation: Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Rosa
authors.initials: R
authors.lastname: Valadao
authors.forename: Erica
authors.initials: E
authors.lastname: Farrand
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Pichardo
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lai
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
mesh_terms: D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications / Q000208:ethnology* / Q000401:mortality; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000208:ethnology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*