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Racial Gap Found in Liver Transplant Survival

Mortality rate higher for blacks, Asians, study finds

MONDAY, Feb. 18, 2002 (HealthDayNews) -- Researchers have discovered a disturbing trend in liver transplants: Blacks and Asians who receive a new one don't do as well as whites and Hispanics who undergo identical operations.

While it's no secret that there are disparities between the races when it comes to medical treatment, a recent study by Johns Hopkins University appears to be the first to link ethnicity to a higher rate of complications and death after liver transplants.

"We're seeing rates in African-Americans that are similar to what we saw in white Americans about 15 years ago," says study co-author Dr. Paul Thuluvath, director of liver transplantation at Hopkins.

It's far from clear where the problem actually lies. "We need to do more studies," Thuluvath says. "The [federal government] should spend some resources to find out what's behind all these things. Otherwise, I'll just be speculating here."

The number of liver transplants in the United States has steadily increased, from just 2,676 in 1990 to almost 4,500 in 1999, according to the United Network for Organ Sharing. In 1999, the latest year for which numbers are available, 8.5 percent of the liver transplants went to blacks. The statistics don't include a small number of transplants in which a portion of a liver is taken from a living donor.

Almost half the liver transplant patients in 1999 suffered from cirrhosis, a scarring of the liver that is often caused by alcoholism.

Thuluvath became intrigued by links between race and liver transplants after noticing that blacks did not do as well as whites after surgery at Johns Hopkins. After a look at Johns Hopkins statistics confirmed his suspicion, Thuluvath checked a national database of all liver transplants from 1988-1996 in the United States.

Only 74 percent of 884 African-Americans lived for two years after the surgery, and only 69 percent of 416 Asian-Americans did. By contrast, 83 percent of 11,762 whites lived for at least two years, as did 79 percent of 1,220 Hispanics.

Whites and Hispanics were also more likely than blacks and Asians to survive for five years after surgery.

"I'm absolutely certain that all patients receive the same treatment," he says. "I don't think there is any difference in the type of care they're getting."

The differences in survival rates could have something to do with different responses to the drugs that prevent people from rejecting transplanted organs, he says. Doctors may need to calibrate the drugs to different ethnicities, he says.

One expert agrees with Thuluvath that racism doesn't affect the survival rates of ethnic groups after liver transplants. If institutional racism did play a role, it would come in "being referred for the transplant, being chosen to have the procedure done," says Dr. Dale Distant, a transplant surgeon with the State University of New York Health Science Center at Brooklyn.

The results of the Hopkins study surprised Distant, who says experts had not thought there was a racial disparity in liver transplant survival rates. However, doctors do know that blacks don't live as long as whites after kidney transplants, he says.

Regardless of the study results, no one should look down on liver transplants, he says. "Saying that the outcome is slightly lower [for minorities] doesn't mean the patients won't benefit from a transplant," he says.

Often, patients have no alternatives, he says. "Liver transplants are performed when the patient is in his last year of life, and there is no other replacement therapy other than a new liver."

The findings were published in the Jan. 26 issue of The Lancet.

What To Do

Learn what the liver does and how to prevent disease by checking out these fact sheets from the American Liver Foundation.

Learn more about liver transplant surgery from the University of Southern California Liver Transplant Program.

SOURCES: Interviews with Paul Thuluvath, M.D., associate professor of medicine and medical director of liver transplantation, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore; Dale Distant, M.D., assistant professor of surgery, transplant surgeon, State University of New York Health Science Center, Brooklyn; Jan. 26, 2002, The Lancet
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