title: Independent effect of black recipient race on short-term outcomes after liver transplantation.
abstract: BACKGROUND
  Previous studies have demonstrated worse graft and patient survival for black patients after liver transplantation (LT), but these studies have not accounted properly for recipient, donor, center, or geographic effects. In this study, we evaluated the effect of candidate race on patient and graft survival after LT.
  
  
  METHODS
  Using a novel linkage of the databases of the University Health System Consortium and the US Census and Scientific Registry of Transplant Recipients, we identified 12,445 patients (43.1% of total) who underwent LT in the United States from 2007 to 2011. Using a mixed-effects, proportional hazards model, we assessed the effect of race on patient and graft survival after controlling for recipient, donor, and center characteristics; region; donor service area; and individual transplant centers.
  
  
  RESULTS
  At the time of transplantation, white patients were healthier, had a shorter duration of hospital stay, and a lesser in-hospital mortality compared with black and Hispanic patients. White recipients had a graft and patient survival advantage when compared with blacks, but there was no survival difference observed when compared with Hispanics. After controlling for recipient and donor characteristics, geographic region, donor service area, and the effect of the individual hospital, black recipients were still at an increased risk of both death (hazard ratio [HR], 1.31; 95% CI, 1.15-1.50) and graft failure (HR, 1.28; 95% CI, 1.14-1.44) after LT.
  
  
  CONCLUSIONS
  After controlling for many of the important variables in the transplant process, including the individual hospital, black recipients were at increased risk of both death and graft failure after LT when compared with whites.
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: quillirc@email.uc.edu.
authors: R Cutler
authors: RC
authors: Quillin
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Gregory C
authors: GC
authors: Wilson
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Koffi
authors: K
authors: Wima
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Dennis J
authors: DJ
authors: Hanseman
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Jeffrey M
authors: JM
authors: Sutton
authors: Surgical Outcomes Analysis & Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA.
authors: Joshua J
authors: JJ
authors: Shaw
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Madison C
authors: MC
authors: Cuffy
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: E Steve
authors: ES
authors: Woodle
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Ian
authors: I
authors: Paquette
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Daniel E
authors: DE
authors: Abbott
authors: Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors: Shimul A
authors: SA
authors: Shah
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D014481:United States; D044465:White People