Changes and mediators of survival disparity among Black liver transplant recipients in the United States
Changes and mediators of survival disparity among Black liver transplant recipients in the United States
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DOI：
10.1111/ajt.16767
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发表时间：
2021-08-10
影响因子：
8.8
通讯作者：
Terrault, Norah A.
中科院分区：
文献类型：
--
作者：
Lee, Brian P.;Dodge, Jennifer L.;Terrault, Norah A.
2002年一项具有里程碑意义的研究发现，与其他种族相比，黑人肝移植（LT）接受者的LT后生存率较低。虽然存在持续的差异，但随着时间的推移发生的变化和调解因素没有得到充分研究。在UNOS中捕获2002年至2018年期间的LT接受者，我们使用logistic回归和考克斯比例风险模型来计算种族之间LT后死亡率的差异。我们研究了移植年份和种族之间的相互作用。一项中介分析评估了可能与LT后生存种族差异相关的生物和环境因素。该队列包括46，997名LT接受者（3898名黑人; 36，560名白色;6539名西班牙裔）。在大多数年份，黑人（与白色相比）LT接受者的年龄调整死亡率概率更高，而在西班牙裔中未观察到。在多变量分析中，黑人（与白人相比）的死亡风险较高（aHR = 1.15，95% CI 1.07-1.24），而西班牙裔死亡风险较低（aHR = 0.78，95% CI 0.72-0.83）。2002年至2009年，黑人（与白人）的LT后死亡率差异缩小，2010年至2013年相似，2014年至2018年可能恶化。LT后1年（与1年内）和非HCV（与HCV）之间的死亡率种族差异较大。酒精相关性肝病（ALD）是2010-2018年黑人-白人差异的最强媒介（13.9%，95%CI 8.7-32.7%）。我们的分析表明，随着随访时间的延长，差异可能会恶化，因为HCV随着消除的努力而消退，并且ALD进一步增加。
A landmark 2002 study identified Black liver transplant (LT) recipients as having lower post-LT survival compared to other races. While persistent disparities exist, changes over time and mediating factors are understudied. Capturing LT recipients between 2002 and 2018 in UNOS, we used logistic regression and Cox proportional-hazard models to calculate differences in post-LT mortality among races. We examined interactions between transplant year and race. A mediation analysis assessed biologic and environmental factors potentially associated with race differences in post-LT survival. The cohort included 46,997 LT recipients (3898 Black;36,560 White;6539 Hispanic). In most years, Black (vs. White) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics. In multivariable analysis, Blacks (vs. Whites) had higher (aHR = 1.15, 95% CI 1.07-1.24), whereas Hispanics had lower (aHR = 0.78, 95% CI 0.72-0.83) risk of mortality. Differences in post-LT mortality among Blacks (vs. Whites) narrowed between 2002 and 2009, were similar between 2010 and 2013, and may have worsened between 2014 and 2018. Race differences were larger for mortality beyond 1-year post-LT (vs. within 1-year), and among non-HCV (vs. HCV). Alcohol-associated liver disease (ALD) was the strongest mediator (13.9%, 95% CI 8.7-32.7%) of the Black-White disparity in 2010-2018. Our analyses suggest disparities may worsen with longer follow-up, as HCV recedes with elimination efforts, and with further increases in ALD.