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Molinari et al. Hepatoma Res 2018;4:56 I http://dx.doi.org/10.20517/2394-5079.2018.71 Page 11 of 15

Overall survival stratified by ethnicity

Legeng: recipient ethnicity

Time (years)

Time after liver transplantation (years)
N. patients at risk 0 1 2 3 4 5
African Americans 531 395 275 202 142 89
Caucasians 4,054 3,124 2,329 1,790 1,295 922
Hispanics 859 669 509 382 295 196
Asians 522 416 333 274 215 161
Multiracial or other minorities 82 66 52 40 32 25

Figure 3. Kaplan-Meier survival functions of patients undergoing liver transplantation for hepatocellular carcinoma in the United States
stratified by ethnicity. The probability of 5-year survival was 81% for patients belonging to multiracial or other minorities, 79% for Asians,
73% for Hispanics, 68% for Caucasians and 56% for African American (P ≤ 0.001)

Patients who undergo LT are only a fraction of the number of patients who are referred but fail selection due
to insufficient social support, inability to travel to transplant centers or lack of resources including health-
care insurance. And, since most of the transplant centers in the United States use comparable criteria for
screening patients with inadequate socio-economic resources, and use the Milan criteria for staging HCC
irrespective of patient ethnicity, we advanced the hypothesis that unless there were biological reasons, there
should not be significant ethnic differences in outcomes after LT.

Overall the results of this study are not novel, yet there are several methodological differences that
distinguish our study from others. First of all, we included only patients who had documented HCC in
their explanted livers. Confirmation that all recipients in this study had HCC is important because up to
11% of patients who are diagnosed with HCC by imaging tests without biopsy prior to LT end up having no
[52]
pathological evidence of neoplastic lesions in their explanted livers . Second, before we analyzed the long-
term outcomes, we confirmed that there were no significant differences in perioperative mortality between
African Americans and other ethnic groups. Proving that the risk of death at 30-, 60-, and 90-day after LT
was similar between the two groups supported the concept that there were no fundamental differences in