title: Effect of ethnicity on liver transplant for hepatocellular carcinoma.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma associated with nonalcoholic fatty liver disease is increasing. We sought to compare tumor characteristics and outcomes after a liver transplant according to the cause of liver disease and ethnicity.
  
  
  METHODS
  We retrospectively evaluated patients with hepatocellular carcinoma (292, 23%) out of all the liver transplant recipients (N=1266) at the University of Miami between 2000 and 2010. Liver disease was caused by hepatitis C virus in 221 patients (76%), nonalcoholic fatty liver disease in 19 patients (6.5%), hepatitis B virus in 20 patients (7%), alcohol in 44 patients (15%), and other in 18 patients (6%). The median age was 57 years (range, 17 to 77 y), 218 were men (75%), 270 were white (92%), and 92 were Hispanic (31.5%).
  
  
  RESULTS
  Patients with hepatocellular carcinoma and nonalcoholic fatty liver disease were more likely to be older (64 vs 57; P = .0006), Hispanic (58% vs 30%; P = .018); nonsmokers (89% vs 65%; P = .041), diabetic (84% vs 26% P < .0001), hypertensive (63% vs 27%; P = .003), and using statins (32% vs 4%; P = .0004) compared with hepatocellular carcinoma without nonalcoholic fatty liver disease. Diabetes, hypertension, and nonalcoholic fatty liver disease are significantly more common in Hispanics than in non-Hispanic persons with hepatocellular carcinoma. In persons without hepatocellular carcinoma, the proportion of Hispanics was similar between those with (n=84) and those without (n=1182) nonalcoholic fatty liver disease. Hispanic ethnicity was not associated with worse tumor behavior or overall survival.
  
  
  CONCLUSIONS
  Patients transplanted for hepatocellular carcinoma and nonalcoholic fatty liver disease were older, and were more frequently Hispanic than were persons with hepatocellular carcinoma and without [corrected] nonalcoholic fatty liver disease. Hispanic ethnicity may be a risk factor for hepatocellular carcinoma.
authors.affiliation: Department of Internal Medicine and Instituto Alfa de Gastroenterologia, School of Medicine, Federal University of Minas Gerais, BH, Brazil.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Couto
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Gelape
authors.forename: Fernando
authors.initials: F
authors.lastname: Calmet
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Cynthia
authors.initials: C
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005234:Fatty Liver / Q000208:ethnology* / Q000401:mortality; D005260:Female; D005431:Florida / Q000453:epidemiology; D006509:Hepatitis B / Q000208:ethnology; D006526:Hepatitis C / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008108:Liver Diseases, Alcoholic / Q000208:ethnology; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult