Patients in the United States with sickle cell disease (SCD) who undergo liver transplantation can have equal graft and survival outcomes compared with a propensity score-matched group and the general population individuals who have received a liver transplant, according to data from the Scientific Registry of Transplant Recipients (SRTR) published in the Journal of Surgical Research.
A team of investigators reviewed outcomes in propensity score-matched liver transplant recipients with SCD and compared these outcomes to a reference population of African American liver transplant recipients in the SRTR. The investigators also reviewed their institutional experience in liver transplantation among patients with SCD.
A total of 23 patients with SCD underwent liver transplantation and 5 patients underwent simultaneous liver and kidney transplantation. Patients were significantly more likely to be African American, children, and to have a lower body mass index. Patients were also significantly less likely to have diabetes.
In addition, patients with SCD who received liver transplants had significantly higher model for end-stage liver disease scores compared with the SRTR population (P =.004), were more likely to be preoperatively admitted to intensive care unit (P =.007), and were more likely to undergo preoperative dialysis (P =.009).
Although patients with SCD were at higher risk at the time of transplantation, their posttransplant graft and survival were comparable to the reference population (P =.5 and P =.2, respectively).
“The overall low numbers of [liver transplantation] in this population compared with the observed frequency of chronic liver disease suggests that there may be a disparity in access to [liver transplantation] for patients with SCD,” the investigators noted.
“Further studies are required to explore chronic liver disease in patients with SCD and determine if a true disparity in access exists. Experienced transplant centers should collaborate with sickle cell specialists to improve access to [liver transplantation] for this complex patient population,” the researchers concluded.
Hogen R, Kim M, Lee Y, et al. Liver transplantation in patients with sickle cell disease in the United States [published online June 12, 2020]. J Surg Res. 2020;255:23-32.