Indications for liver transplantation in British Columbia's Aboriginal population: A 10-year retrospective analysis

OBJECTIVES:To study the indications for liver transplantation among British Columbia's First Nation population. MATERIALS AND METHODS: A retrospective analysis of the British Columbia Transplant Society's database of Aboriginal and non-Aboriginal liver transplant recipients from 1989 to 1998 was undertaken. For primary biliary cirrhosis (PBC), the transplant assessment database (patients with and without transplants) was analyzed using a binomial distribution and compared with published census data regarding British Columbia's proportion of Aboriginal people. RESULTS: Between 1989 and 1998, 203 transplantations were performed in 189 recipients. Fifteen recipients were Aboriginal (n = 15; 7.9%). Among all recipients, the four most frequent indications for liver transplantation were hepatitis C virus (HCV) infection (n = 57; 30.2%), PBC (n = 34; 18.0%), alcohol (n = 22; 11.6%) and autoimmune hepatitis (n = 14; 7.4%). Indications for liver transplantation among Aboriginal people were PBC (n = 8; 53.3%; P < 0.001 compared with non-Aboriginal people), autoimmune hepatitis (n = 4; 26.67%; P = 0.017), acute failure (n = 2; 13.3%) and HCV (n = 1). Among all patients referred for liver transplantation with PBC (n = 43), 29 (67.44%) were white and 11 (25.6%) were Aboriginal. A significant difference was found between the proportion of Aboriginal people referred for liver transplantation and the proportion of Aboriginal people in British Columbia (139,655 of 3,698,755 [3.8%]; 1996 Census, Statistics Canada) (P < 0.001). CONCLUSIONS: Aboriginal people in British Columbia are more likely to be referred for liver transplantation with a diagnosis of PBC but are less likely to receive a liver transplant because of HCV or alcohol than are non-Aboriginal people.