African Americans with Hepatitis C Have Worse Outcomes than White Patients after Liver Transplantation

SUMMARY: African-American individuals who undergo liver transplants due to complications of hepatitis C virus (HCV) infection experience more rapid post-transplant fibrosis progression and histological inflammation compared with white patients, even though they tend to experience slower pre-transplant disease progression, according to a study presented at the recent 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009) in Boston.

Below is the text of a press release issued by AASLD describing the study and its findings.

African Americans Fare Worse After Undergoing
Liver Transplantation Due to Hepatitis C

Alexandria, VA and Boston, MA -- October 31, 2009 -- Previous studies have shown that hepatitis C virus (HCV) progresses slower prior to liver transplantation in African Americans than in whites. However, researchers demonstrate in this study, which will be presented at the annual meeting of the American Association for the Study of Liver Diseases, that the opposite is true after transplantation, in that recurrent HCV in the transplanted liver progresses faster in African Americans than in whites. "I believe this study highlights the need, in all patients, for early close clinical monitoring, including the use of early protocol biopsies, to identify these patients that have early disease progression post-transplantation," said Jennifer Layden, MD, PhD, principal investigator on this study.

This retrospective multisite cohort study of 771 patients from 5 sites evaluated patients who had a liver transplantation between 1999 and 2008. All patients were transplanted due to liver failure caused by HCV. Data were analyzed at 6 months, 1 year, and 2 years after transplantation.

The researchers found, based on an analysis of liver biopsies performed after transplantation, that African Americans had more severe fibrosis progression and histologic inflammation compared to whites following liver transplantation for HCV. While Hispanics demonstrated similar disease progression after liver transplantation as whites, African Americans more often experienced graft failure and required repeat liver transplantation compared to whites. In addition, the hazard ratio for patient death for African Americans was 1.3, indicating a 30% higher mortality for African Americans compared to whites. The researchers concluded that African Americans who undergo liver transplantation caused by HCV had more severe fibrosis progression and histologic inflammation compared to whites undergoing the same procedure.

"While this study illustrates that HCV histologic progression occurs early and is more aggressive in African Americans, it does not allow a careful analysis of factors that may be contributing to these differences," concluded Dr. Layden, "we are conducting a multi-site prospective study to not only confirm these retrospective findings, but also examine both donor and host factors, including psychosocial, virologic, genetic and immunologic that may contribute to this important health disparity."

About the AASLD

AASLD is the leading medical society focused solely on advancing the science and practice of hepatology and represents more than 3,300 practitioners, researchers, and allied health professionals worldwide. Founded by physicians in 1950, AASLD has upheld the standards of the profession and fostered research that generates treatment options for the millions of patients with liver diseases.

12/15/09

Reference

JE Layden, K Brown, MR Lucey, and others. Hepatitis C Virus (HCV) progresses more rapidly after orthotopic liver tranplantation (OLT) in African Americans (AA) compared to whites (W). 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009). Boston. October 30-November 1, 2009. Abstract 190.

Other source

American Association for the Study of Liver Diseases. African Americans Fare Worse After Undergoing Liver Transplantation Due to Hepatitis C. Press release. October 31, 2009.