Premium
Black Race Is Associated With Higher Rates of Early‐Onset End‐Stage Renal Disease and Increased Mortality Following Liver Transplantation
Author(s) -
Alvarado Meagan,
Schaubel Douglas E.,
Reddy K. Rajender,
Bittermann Therese
Publication year - 2021
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.26054
Subject(s) - medicine , dialysis , hemodialysis , transplantation , hazard ratio , liver transplantation , renal function , end stage renal disease , kidney disease , odds ratio , liver disease , diabetes mellitus , gastroenterology , endocrinology , confidence interval
Black race is a risk factor for end‐stage renal disease (ESRD). Racial disparities in the risks of early and long‐term renal complications after liver transplantation (LT) have not been systematically studied. This study evaluated racial differences in the natural history of acute and chronic renal insufficiency after LT. This was a retrospective single‐center cohort study of 763 non‐Hispanic White and 181 Black LT recipients between 2008 and 2017. Black race was investigated as an independent predictor of the following outcomes: (1) receipt and duration of early post‐LT hemodialysis and (2) time to post‐LT ESRD. The interaction of race and post‐LT ESRD on survival was also studied. Black recipients had higher rates of pre‐LT hypertension ( P < 0.001), but diabetes mellitus and renal function before LT were not different by race (all P > 0.05). Overall, 15.2% of patients required early hemodialysis immediately after LT with no difference by race (covariate‐adjusted odds ratio, 0.89; P = 0.71). Early dialysis discontinuation was lower among Black recipients (covariate‐adjusted hazard ratio [aHR], 0.47; P = 0.02), whereas their rate of post‐LT ESRD was higher (aHR, 1.91; P = 0.005). Post‐LT survival after ESRD was markedly worse for Black (aHR, 11.18; P < 0.001) versus White recipients (aHR, 5.83; P < 0.001; interaction P = 0.08). Although Black and White LT recipients had comparable pretransplant renal function, post‐LT renal outcomes differed considerably, and the impact of ESRD on post‐LT survival was greater for Black recipients. This study highlights the need for an individualized approach to post‐LT management to improve outcomes for all patients.