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."
Review: The multifaceted roles of bilirubin in liver health and disease