Donor Race May Play a Role in Survival of Transplant Patients With Liver Cancer

African-Americans who received a racially matched liver had better survival outcomes compared with unmatched patients, according to a review of national data.
BY Katie Kosko
PUBLISHED January 24, 2019
African-American adults with liver cancer who received a racially-matched donor during transplantation lived, on average, 4.75 years longer than unmatched patients, according to findings published in the Journal of the American College of Surgeons.

A team of researchers from the Medical College of Wisconsin in Milwaukee used the Organ Procurement and Transplantation Network’s national database to identify 15,141 patients with first-time hepatocellular carcinoma (HCC) — the most common form of liver cancer. Patients received a transplant from a deceased donor between 1994 and 2015.

Specifically, they looked at African-American patients, which made up 9.1 percent (1,384 patients) of recipients. Of those recipients, 23.5 percent (325 patients) received livers from African-American donors and 76.5 percent (1,059 patients) were unmatched.

“Race has not played a role in who gets what organ ever,” lead investigator T. Clark Gamblin, M.D., M.S., M.B.A., F.A.C.S., professor and chief of surgical oncology at the Medical College of Wisconsin, said in an interview with CURE. “It’s very random who gets an African-American (donor’s) liver and who gets a non-African-American (donor’s) liver. It’s somewhat of a randomized fashion that they received these organs on the basis of race, so we thought it would be intriguing to see if there was some benefit.”

Currently, donated livers are matched by size, blood type and health of the organ, with age sometimes playing a role, Gamblin explained.

Researchers found that 64.2 percent of race-matched patients were alive five years after transplant compared with 56.9 percent of unmatched patients.

“African-American transplant recipients had 34 percent greater odds of long-term survival when the donor’s race was the same,” investigators wrote. However, when a liver was received from a white donor there was a reported 53 percent increased risk of death, they added.

“These are preliminary findings and they are not definitive answers to questions,” Gamblin said. “But they are intriguing results that show that in African-American patients the data lends us to believe that if they receive an African-American (donor’s) liver, those patients seem to survive longer and do better.”

Previous research has found that compared with other races, African-American patients with HCC tend to have the poorest long-term survival and have worse outcomes after liver transplant.

This year, more than 42,000 cases of primary liver cancer and intrahepatic bile duct cancer are estimated to be diagnosed in the United States, according to the American Cancer Society. Globally, liver cancer is a leading cause of cancer death. Treating the disease in hope of curing the patient requires surgery — either removing the tumor or a liver transplant.  

Gamblin hopes to further this research by examining patient data from larger transplant centers. “In medicine, we are constantly trying to optimize outcomes,” he added. “We are looking retrospectively at outcomes to try to think about the patient of tomorrow.”

 
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