Liver Transplantation for Hepatocellular Carcinoma among African Americans in the United States

Abstract

Background: There is increased prevalence of hepatocellular carcinoma (HCC) among African Americans(AA). Multicenter studies have shown advanced presentation, underutilization of treatment and decreasedsurvival following liver transplantation (LT) among AA. However outcomes from single centersare not well reported.Objective: To determine the outcome of AA undergoing LT for HCC at Cleveland Clinic, Cleveland, Ohio,between May 2007 and December 2009.Methods: 245 consecutive patients undergoing evaluation and treatment for HCC within the mentionedtime frame were studied, retrospectively.Results: 80% of patients were male, 75.5% were Caucasian, 16.7% were AA and 7.8% were other ethnicgroups. Compared to other ethnicities, AA subjects with HCC were more commonly female and weremore likely to have hepatitis C virus (HCV) (83% vs. 51%, p<0.001). There were higher occurrence ofHCV genotype 1 among AA compared to others among patients with this information (100% vs. 65%,p<0.001). In contrast to previous reports, there was no significant difference between the groups in termsof clinical presentation or management. 27% of AA underwent liver transplantation compared to 28% ofthe rest (p=0.88). Of the 68 patients who had LT, 9% died with no difference in post-LT survival betweenthe two groups.Conclusions: HCV (and genotype 1) is a significant risk factor for HCC in the AA population. LT results insimilar survival compared to other ethnicities. AA patients with HCC benefit equally from LT comparedto other ethnicities.

Keywords

• Liver transplantation
• Survival
• Hepatocellular carcinoma
• HCC
• outcomes
• African Americans
• HCV
• Mortality