Black Race is Associated with Higher Rates of Early Onset End-Stage Renal Disease and Increased Mortality Following Liver Transplantation.

Black race is a risk factor for end-stage renal disease (ESRD). Racial disparities in the risks of early and long-term renal complications after liver transplantation (LT) have not been systematically studied. This study evaluated racial differences in the natural history of acute and chronic renal insufficiency after LT. This was a retrospective single-center cohort study of 763 non-Hispanic White and 181 Black LT recipients between 2008-2017. Black race was investigated as an independent predictor of the following outcomes: (i) receipt and duration of early post-LT hemodialysis, and (ii) time to post-LT ESRD. The interaction of race and post-LT ESRD on survival was also studied. Black recipients had higher rates of pre-LT hypertension (p 0.05). Overall, 15.2% required early dialysis post-LT with no difference by race (aOR=0.89; p=0.71). Early dialysis discontinuation was lower among Black recipients (aHR=0.47; p=0.02), while their rate of post-LT ESRD was higher (aHR=1.91; p=0.005). Post-LT survival after ESRD was markedly worse for Black (aHR=11.18; p<0.001) versus White recipients (aHR=5.83; p<0.001; interaction p=0.08). CONCLUSION: Although Black and White LT recipients had comparable pre-transplant renal function, post-LT renal outcomes differed considerably and the impact of ESRD on post-LT survival was greater for Black recipients. This study highlights the need for an individualized approach to post-LT management to improve outcomes for all.