Systematic review and meta-analysis shows worse liver transplant survival for Black patients compared to White patients

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The Journal of surgical research Published May 7, 2026 Medically reviewed May 8, 2026 Study authors: Nasir Muhammad Umar, Umer Muhammad, Rizwan Abdul Wahid, Jehangir Hanzala, Tariq Muhammad Umar, Mehdi… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note worse post-transplant survival for Black patients versus White patients in this meta-analysis.

This systematic review and meta-analysis examined overall patient and graft survival after liver transplant across diverse ethnic populations, including White, Black, Asian, and Hispanic groups. The authors synthesized data from twelve retrospective cohort studies to compare outcomes between Black, Asian, and Hispanic patients versus White patients. Follow-up duration was not reported, and the analysis was irrespective of follow-up duration.

The meta-analysis found that Black patients had worse survival rates compared to White patients. The pooled hazard ratio was 1.27 with a 95% CI of 1.12, 1.44 and a P value of 0.002. In contrast, Asian patients showed similar survival chances to White patients with a hazard ratio of 0.90 and a 95% CI of 0.79, 1.02. Hispanic patients also demonstrated similar survival chances with a hazard ratio of 0.86 and a 95% CI of 0.71, 1.05. The certainty note indicates moderate confidence in the meta-analysis effect estimates.

The authors highlight several limitations and suggest that future research should involve larger, multi-ethnic cohorts. They recommend adjusting for key confounding variables and exploring factors underlying worse post-transplant outcomes in certain racial groups. Funding or conflicts were not reported, and adverse events were not reported. The study setting was not reported.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID41921472

View Original Abstract ↓

INTRODUCTION: Liver transplant remains the favored modality for the treatment of hepatocellular carcinoma. However, disparities in post-transplant outcomes across ethnic groups persist. Our review aimed to clarify the association between ethnicity and the studied outcomes. METHODS: A systematic literature search in accordance with the PRISMA protocol extracted articles from inception upto April 21, 2025. Outcomes of interest included overall patient and graft survival after liver transplant. The Newcastle-Ottawa Scale assessed the risk of bias. Meta-analysis was performed using the random effects model in RevMan Web. The GRADE tool assessed certainty of evidence. RESULTS: The review included twelve retrospective cohort studies covering diverse ethnic populations, including White, Black, Asian, and Hispanic groups. Across the studies reviewed, Black patients generally showed the poorest overall patient and graft survival, whereas Asian patients tended to have the best patient survival, irrespective of follow-up duration. Meta-analyses found that Black patients (HR = 1.27; 95% CI = 1.12, 1.44; P = 0.002; I = 55%) had worse posttransplant survival rates, while Asian patients (HR = 0.90; 95% CI = 0.79, 1.02; P = 0.11; I = 0%) and Hispanic patients (HR = 0.86; 95% CI = 0.71, 1.05; P = 0.15; I = 59%) had similar survival chances compared to White patients, with moderate confidence in the meta-analysis effect estimates. CONCLUSIONS: Black patients with hepatocellular carcinoma had consistently worse post-transplant outcomes compared to other ethnicities. Future research should involve larger, multi-ethnic cohorts, adjust for key confounding variables, and explore factors underlying worse post-transplant outcomes in certain racial groups.