Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

Background. Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes. Aim. To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. Study. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan–Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis. Results. African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1–1.58, P = 0.046 ) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98–1.23, P = 0.081 ). Conclusions. Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.

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New OPTN Simultaneous Liver-Kidney Transplant (SLKT) Policy Improves Racial and Ethnic Disparities

Journal of Clinical Medicine ◽

10.3390/jcm9123901 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3901

Author(s):

Daniela Goyes ◽

John Paul Nsubuga ◽

Esli Medina-Morales ◽

Vilas Patwardhan ◽

Alan Bonder

Keyword(s):

African Americans ◽

Risk Analysis ◽

Graft Survival ◽

Cox Regression ◽

Ethnic Disparities ◽

Competing Risk ◽

Survival Outcomes ◽

Racial And Ethnic Disparities ◽

Competing Risk Analysis ◽

Eligibility Criteria

(1) Background: On 10 August 2017, the Organ Procurement and Transplantation Network (OPTN) adopted standardized eligibility criteria to properly determine which transplant candidates should undergo Simultaneous Liver-Kidney Transplant (SLKT). Racial and ethnic disparities have not been examined after 2017. Therefore, using the United Network for Organ Sharing (UNOS), we aim to evaluate post-graft survival outcomes among Caucasians, African Americans, and Hispanics. (2) Methods: Kaplan–Meier curves and Cox regression models are used to compare post-transplant graft survival for Caucasians, African Americans (AAs), and Hispanics. Competing risk analysis is used to evaluate the cumulative incidence of death or re-transplantation with re-transplantation and death as competing risks. (3) Results: On multivariate Cox regression analysis, no differences in graft survival are found in AA (hazard ratio (HR): 1.30; 95% CI: 0.74–2.29 p = 0.354) or Hispanics (HR: 1.18; 95% CI: 0.70–2 p = 0.520) compared to Caucasians after 2017. On competing risk analysis of the risk of death with re-transplantation as a competing risk, no difference is found between ethnic minorities after 2017. There is a similar finding from competing risk analysis of the risk of re-transplantation with death as a competing risk. (4) Conclusion: After introducing standardized eligibility criteria for SLKT allocation, the post-graft survival outcomes remain similar between the different racial and ethnic groups, displaying the benefits of adopting such policy in 2017.

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Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease

Journal of Clinical Medicine ◽

10.3390/jcm9020319 ◽

2020 ◽

Vol 9 (2) ◽

pp. 319

Author(s):

Jaspreet S. Suri ◽

Christopher J. Danford ◽

Vilas Patwardhan ◽

Alan Bonder

Keyword(s):

Liver Disease ◽

Risk Analysis ◽

Liver Transplant ◽

Autoimmune Hepatitis ◽

Competing Risk ◽

Clinical Deterioration ◽

Primary Biliary Cholangitis ◽

Competing Risk Analysis ◽

Subdistribution Hazard ◽

Similar Risk

Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.

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A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort

Journal of Hepatology ◽

10.1016/j.jhep.2017.11.030 ◽

2018 ◽

Vol 68 (4) ◽

pp. 707-714 ◽

Cited By ~ 50

Author(s):

Jeroen Laurens Ad van Vugt ◽

Louise Johanna Maria Alferink ◽

Stefan Buettner ◽

Marcia Patricia Gaspersz ◽

Daphne Bot ◽

...

Keyword(s):

Risk Analysis ◽

Liver Transplant ◽

Meld Score ◽

Cirrhotic Liver ◽

Waiting List ◽

Competing Risk ◽

Competing Risk Analysis ◽

National Cohort ◽

Transplant Candidates

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A nomogram with sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant patients: a competing risk analysis in a national cohort

Journal of Hepatology ◽

10.1016/s0168-8278(18)30981-4 ◽

2018 ◽

Vol 68 ◽

pp. S377-S378 ◽

Cited By ~ 2

Author(s):

J. van Vugt ◽

L. Alferink ◽

S. Buettner ◽

M. Gaspersz ◽

D. Bot ◽

...

Keyword(s):

Risk Analysis ◽

Liver Transplant ◽

Meld Score ◽

Cirrhotic Liver ◽

Waiting List ◽

Competing Risk ◽

Competing Risk Analysis ◽

Transplant Patients ◽

National Cohort

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Evaluating Overall Survival and Competing Risks of Survival in Patients With Early Stage Breast Cancer Using a Comprehensive Nomogram

10.21203/rs.2.14758/v1 ◽

2019 ◽

Author(s):

Yanbo Xu ◽

Hong Liu ◽

Qi-Hua Cao ◽

Jia-Li Ji ◽

Rong-Rong Dong ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Risk Analysis ◽

Tumor Size ◽

Cox Regression ◽

Early Stage ◽

Competing Risk ◽

Competing Risk Analysis ◽

Cox Regression Analysis ◽

Specific Mortality

Abstract BackgroundPatients with early stage breast cancer (BC) live long but accompany with competing comorbidities. This study aims to estimate the impact of cancer and non-cancer causes of death in early stage BC patients, and further quantify the survival differences. MethodsPatients diagnosed with breast cancer between 2010 and 2016 from the Surveillance, Epidemiology, and End Results database were enrolled in the study. Cumulative incidence function (CIF) for cause-specific death and other causes of death were estimated, and the differences were tested by Gray’s test. Nomogram for estimating 3-, 4-, and 5-year overall survival, cancer-specific survival and other-cause-specific survival was established based on Cox regression analysis and Fine and Gray’s competing risk analysis. The discriminative ability, calibration and precision of the nomogram was evaluated and compared using C statistics, calibration plots and the area under receiver operating characteristic curve. Results196304 eligible patients with early-stage BC patients were enrolled in this study. Prolonged overall survival (OS) was associated with younger age, well differentiation, smaller tumor size, Luminal subtype and presence of surgery ( p <0.001). For competing events, Fine and Gray's competing risk analysis was used to validate the predictors: i ncreasing age, poorer differentiation, larger tumor size, triple negative subtype, HER2 enriched subtype and absence of surgery for cancer-specific mortality (CSM); and increasing age, larger tumor size and absence of surgery for other-cause-specific mortality (OCSM). The established nomogram was well calibrated, and displayed good discrimination in both training cohort and validation cohort by calibration plots (Figure 4), with a concordance index of 0.801 (95% CI, 0.795-0.806; p =0.003) for OS prediction; 0.830 (95% CI, 0.824-0.836; p =0.003) for CSM prediction and 0.806 (95% CI, 0.798-0.814; p =0.004) for OCSM prediction. Furthermore, the AUC values for predicting survival and death were: OS, 80.2% (3-year), 79.5% (4-year), and 78.7% (5-year); CSM, 83.0% (3-year), 81.7% (4-year), and 80.3% (5-year); OCSM 81.3% (3-year), 80.8% (4-year), and 81.7% (5-year) (Figure 5). ConclusionsWe evaluated OS and CIF of cancer-specific death and other-cause-specific death in patients with early stage BC based on Cox regression analysis and Fine and Gray’s competing risk analysis and developed the first comprehensive prognostic nomogram.

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Effects of Albumin on Survival after a Hepatic Encephalopathy Episode: Randomized Double-Blind Trial and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10214885 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4885

Author(s):

Meritxell Ventura-Cots ◽

Macarena Simón-Talero ◽

Maria Poca ◽

Xavier Ariza ◽

Helena Masnou ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Risk Analysis ◽

Controlled Trial ◽

Meta Analysis ◽

Survival Rates ◽

Competing Risk ◽

Competing Risk Analysis ◽

Double Blind ◽

Clinical Events ◽

Grade Ii

No therapies have been proven to increase survival after a hepatic encephalopathy (HE) episode. We hypothesize that two doses of albumin could improve 90-day survival rates after a HE episode. Methods: (1) A randomized double-blind, placebo-controlled trial (BETA) was conducted in 12 hospitals. The effect of albumin (1.5 g/kg at baseline and 1 g/kg on day 3) on 90-day survival rates after a HE episode grade II or higher was evaluated. (2) A meta-analysis of individual patient’s data for survival including two clinical trials (BETA and ALFAE) was performed. Results: In total, 82 patients were included. Albumin failed to increase the 90-day transplant-free survival (91.9% vs. 80.5%, p = 0.3). A competing risk analysis was performed, observing a 90-day cumulative incidence of death of 9% in the albumin group vs. 20% in the placebo (p = 0.1). The meta-analysis showed a benefit in the albumin group, with a lower rate of clinical events (death or liver transplant) than patients in the placebo (HR, 0.44; 95% CI, 0.21–0.82), when analyzed by a competing risk analysis (90-days mortality rate of 11% in the albumin group vs. 30% in the placebo, p = 0.02). Conclusions: Repeated doses of albumin might be beneficial for patient’s survival as an add-on therapy after an HE episode, but an adequately powered trial is needed

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Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm3: a 2-institute study including re-analyses of earlier results using competing risk analysis

Journal of Neurosurgery ◽

10.3171/2018.7.gks181392 ◽

2018 ◽

Vol 129 (Suppl1) ◽

pp. 77-85 ◽

Cited By ~ 5

Author(s):

Masaaki Yamamoto ◽

Yoshinori Higuchi ◽

Toru Serizawa ◽

Takuya Kawabe ◽

Osamu Nagano ◽

...

Keyword(s):

Risk Analysis ◽

Brain Metastases ◽

Gamma Knife ◽

Survival Rates ◽

Competing Risk ◽

Published Data ◽

Competing Risk Analysis ◽

Survival Times ◽

Actuarial Survival ◽

Peripheral Dose

OBJECTIVEThe results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series.METHODSThis was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm3, treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method.RESULTSThe overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series.CONCLUSIONSThere were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

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