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Molinari et al. Hepatoma Res 2018;4:56 I http://dx.doi.org/10.20517/2394-5079.2018.71 Page 5 of 15

Figure 1. Analysis of the frequency of postoperative mortality observed in African American patients vs. patients of other ethnicities
undergoing first-time cadaveric liver transplant for hepatocellular carcinoma at 30-, 60-, 90-day and at 1 year after surgery

recipients and 3019 patients had no HCC in their final surgical pathology report of their explanted livers
and were excluded. After the additional removal of 643 recipients who had more than 10% of missing data,
we identified a cohort of 6048 LT recipients who represented the study population. The average age of the
recipients was 58 years and females represented 20% of the cohort. Most patients were Caucasians (67%),
followed by Hispanics (14.2%), African Americans (8.8%) and Asians (8.6%). Detailed demographic and
clinical characteristics of the study population are summarized in Table 1.

Clinical and socio-economic characteristics
When compared to all other ethnic groups, the cohort of African American recipients had a higher
percentage of women (26.2% vs. 19.7%; P ≤ 0.001), was younger with an average age of 57 years vs. 58 years
(P = 0.005), had a greater proportion of patients who required hemodialysis before LT (2.3% vs. 0.7%; P ≤ 0.001),
had fewer patients who had to wait longer than 6 months for LT (34.2% vs. 40.8%; P = 0.02), had a lower
level of education and received a graft from younger donors (42.6 years vs. 44.2 years; P = 0.030). Detailed
comparisons between African American patients and the rest of the cohort are reported in Table 2.

Postoperative mortality and survival
The median follow-up of the cohort was 7.6 years (95% CI: 7.5-7.8). During this period, 2079 patients had died
(34.3%), 3762 were censored (62.2%), and 207 patients (3.4%) were lost at follow-up. Overall 30-, 60-, 90-day
and 1-year mortality was 1.7%, 2.3%, 3.0% and 8.8% respectively with no statistically significant differences
between African Americans and other ethnicities [Figure 1].

Table 3 reports the primary causes of death of patients who died within 5 years after LT. Graft failure was
the most frequent cause of death among African Americans (16.6%), followed by multiorgan failure (15.4%)
and recurrent malignancy (15.4%). On the other hand, the most frequent known causes of deaths in patients
belonging to other ethnic groups were recurrent malignancy (31.1%), graft failure (11.4%) and infections (9.0%)
(P < 0.001).

Kaplan-Meier survival function showed that the 5-year probability of survival for all patients who underwent
LT for HCC was 69% [Figure 2]. Comparisons of survival functions by ethnicity showed that African
American had the lowest 5-year survival with statistically significant differences between African Americans
and all the other ethnic groups (P ≤ 0.001) [Figure 3].