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Old 08-31-2009, 07:16 PM
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Default Race not a factor in liver transplantation

– Racial disparities exist in many areas of health care, from heart disease treatment to rates of surviving cancer. And studies have suggested that white patients do better than African Americans following liver transplants. But race may not play a role in survival after liver transplants for hepatitis B infection, nor while waiting for one, according to a new study.

But an expert in the field who was not involved in the study cautions that the number of African-Americans included in the study -- just 23, 17 of whom underwent transplantation -- is too small to conclude that there are no racial disparities in survival on the "wait list" or after transplant.
Up to 2 million Americans are infected with the hepatitis B virus (HBV), and liver disease due to HBV infection accounts for up to 10 percent of liver transplants.
Several studies found that Asians who underwent transplantation for HBV infection fared worse than whites, but there is little information available on how African-Americans do after transplant for HBV, or on wait list outcomes for Asians or African-Americans, Dr. Natalie Bzowej of California Pacific Medical Center in San Francisco and her colleagues note.
To investigate, Bzowej and her team looked at 274 patients awaiting liver transplants for HBV infection at 15 different US centers, including 116 whites, 135 Asians, and 23 African-Americans. All had gone on the United Network of Organ Sharing wait list between 1996 and 2005.
The researchers found no racial disparities in the probability that a patient would receive a transplant, or survive on the wait list. Five years after the transplant, 94 percent of African-Americans were alive, compared to 85 percent of Asian Americans and 89 percent of whites, they report in the journal Liver Transplantation.
The only factor associated with survival after transplant was whether or not a patient had recurrence of liver cancer, and recurrence of the disease was the same in the three racial groups.
But within four years of undergoing transplant, 19 percent of white patients had a recurrence of HBV, compared to 7 percent of Asians and 6 percent of blacks. Whether or not a patient's HBV returned after transplant didn't influence their survival after the procedure.
In an editorial accompanying the study, Dr. Charles D. Howell of the University of Maryland School of Medicine in Baltimore points out that a study looking at liver transplantation for HBV between 1997 and 2001 found that while whites and Asians had similar survival rates, survival was less likely for African Americans.
The current study, he argues, included too few African-Americans for "dependable conclusions" to be drawn about whether African-Americans fare worse -- or the same --after liver transplant for HBV compared to other ethnic groups.
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