Liver transplantation in patients with a history of migration—A German single center comparative analysis

Autoři: Julian Nikolaus Bucher aff001;  Maximilian Koenig aff001;  Markus Bo Schoenberg aff001;  Alexander Crispin aff002;  Michael Thomas aff001;  Martin Kurt Angele aff001;  Daniela Eser-Valeri aff003;  Alexander Lutz Gerbes aff004;  Jens Werner aff001;  Markus Otto Guba aff001
Působiště autorů: Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany aff001;  Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany aff002;  Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany aff003;  Department of Medicine 2, Ludwig-Maximilians-University Munich, Munich, Germany aff004;  Transplantation Centre Munich, Ludwig-Maximilians-University Munich, Munich, Germany aff005;  Liver Centre Munich, Ludwig-Maximilians-University Munich, Munich, Germany aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224116


Liver transplant (LT) programs in Germany increasingly face a multiethnic patient population. To date no outcome data for LT in patients with a history of migration is available for Germany. This complicates decision-making before wait-listing such patients. We conducted a single-center cohort analysis of all primary LT between April 2007 and December 2015, stratified for the history of migration to investigate differences in the outcome. We found transplant rates resembling the proportion of persons with a history of migration in the general public in the region of our center. Differences were found concerning age at LT and prevalence of underlying diseases. Re-Transplant rates, Kaplan-Meier Estimates for overall survival, also after stratification for viral hepatitis, sex, ethnicity or presence of a language-barrier showed no statistical differences. The multivariate analysis showed no migration-related covariate associated with a negative outcome. These results stand in contrast to most of the previous evidence from North America and the UK and need to be taken into consideration during the wait-listing process of patients with a history of migration in need of a LT in centers in the Eurotransplant region.

Klíčová slova:

Cirrhosis – German people – Germany – Hepatitis B – Liver transplantation – Verbal communication – Autoimmune hepatitis – Hepatitis C


1. Bradby H, Humphris R, Newall D, Phillimore J. Public Health Aspects of Migrant Health: A Review of the Evidence on Health Status for Refugees and Asylum Seekers in the European Region. In: WHO Health Evidence Network Synthesis Reports.

2. Razum O, Karrasch L, Spallek J. Migration: A neglected dimension of inequalities in health? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59(2):259–65. 26661589

3. Lehner F. Refugees—new challenge in transplantation. Leiden, The Netherlands; 2016. (Eurotransplant Annual Meeting 2016) [cited 2017 Mar 19]. URL:

4. Bernardi M, Gitto S, Biselli M. The MELD score in patients awaiting liver transplant: strengths and weaknesses. J Hepatol 2011; 54(6):1297–306. doi: 10.1016/j.jhep.2010.11.008 21145851

5. Dossetor JB. Economic, social, racial and age-related considerations in dialysis and transplantation. Curr Opin Nephrol Hypertens 1995; 4(6):498–501. doi: 10.1097/00041552-199511000-00007 8591058

6. Nair S, Eustace J, Thuluvath PJ. Effect of race on outcome of orthotopic liver transplantation: a cohort study. Lancet 2002; 359(9303):287–93. doi: 10.1016/S0140-6736(02)07494-9 11830194

7. Wong RJ, Ahmed A. Combination of racial/ethnic and etiology/disease-specific factors is associated with lower survival following liver transplantation in African Americans: an analysis from UNOS/OPTN database. Clin Transplant 2014; 28(7):755–61. doi: 10.1111/ctr.12374 24750171

8. Dooldeniya MD, Dupont PJ, He X, Johnson RJ, Joshi T, Basra R et al. Renal transplantation in Indo-Asian patients in the UK. Am J Transplant 2006; 6(4):761–9. doi: 10.1111/j.1600-6143.2006.01262.x 16539633

9. Rudge C, Johnson RJ, Fuggle SV, Forsythe JLR. Renal transplantation in the United Kingdom for patients from ethnic minorities. Transplantation 2007; 83(9):1169–73. doi: 10.1097/ 17496531

10. Medcalf JF, Andrews PA, Bankart J, Bradley C, Carr S, Feehally J et al. Poorer graft survival in ethnic minorities: results from a multi-centre UK study of kidney transplant outcomes. Clin Nephrol 2011; 75(4):294–301. doi: 10.5414/cn106675 21426883

11. Roodnat JI, Zietse R, Rischen-Vos J, van Gelder T, Mulder PG, Ijzermans JN et al. Effect of race on kidney transplant survival in non-European recipients. Transplant Proc 1999; 31(1–2):312–3. doi: 10.1016/s0041-1345(98)01641-8 10083122

12. Roodnat JI, Zietse R, Rischen-Vos J, van Gelder T, Mulder PG, Ijzermans JN et al. Renal graft survival in native and non-native European recipients. Transpl Int 1999; 12(2):135–40. doi: 10.1007/s001470050198 10363596

13. Molnar MZ, Langer RM, Remport A, Czira ME, Rajczy K, Kalantar-Zadeh K et al. Roma ethnicity and clinical outcomes in kidney transplant recipients. Int Urol Nephrol 2012; 44(3):945–54. doi: 10.1007/s11255-011-0088-6 22116678

14. Devlin JJ, O’Grady JG, Tan KC, Calne RY, Williams R. Ethnic variations in patient and graft survival after liver transplantation. Identification of a new risk factor for chronic allograft rejection. Transplantation 1993; 56(6):1381–4. doi: 10.1097/00007890-199312000-00020 8279007

15. Unabhängige Kommission "Zuwanderung". Bericht der unabhängigen Kommission "Zuwanderung" 2001. Berlin; 2001.

16. Interagency-Language-Roundtable.; 2009 [cited 2017 Mar 28]. URL:

17. Volker Leinweber. vBW—die Bayerische Wirtschaft: Wirtschaftsdaten—Oberbayern. p. 1 [cited 2017 Mar 8]. URL:

18. Anna Lutz FH. Bayerisches Staatsministerium für Arbeit und Sozialordung, FAmilie und Frauen: Die Bevölkerung mit Migrationshintergrund in Bayern [Stand der Integration und integrationspolitische Maßnahmen]. p. 34–43 [cited 2017 Mar 8].

19. Statistische Ämter des Bundes und der Länder, editor. Zensus 2011: Staatsangehörigkeit und Migration [Endgültige Ergebnisse] 2016.

20. Mikolajczyk RT, Akmatov MK, Stich H, Kramer A, Kretzschmar M. Association between acculturation and childhood vaccination coverage in migrant populations: a population based study from a rural region in Bavaria, Germany. Int J Public Health 2008; 53(4):180–7. doi: 10.1007/s00038-008-8002-4 18716721

21. Marschall T, Kramer A, Prufer-Kramer L, Mikolajczyk R, Kretzschmar M. Does migration from high and intermediate endemic regions increase the prevalence of hepatitis B infection in Germany? Dtsch Med Wochenschr 2005; 130(48):2753–8. doi: 10.1055/s-2005-922067 16307403

22. Sharma S, Carballo M, Feld JJ, Janssen HL. Immigration and viral hepatitis. J Hepatol; 63(2):515–22. doi: 10.1016/j.jhep.2015.04.026 25962882

23. Spallek J, Razum O. Migration und Gesundheit. In: Richter M, Hurrelmann K, editors. Soziologie von Gesundheit und Krankheit. Wiesbaden: Springer Fachmedien Wiesbaden; 2016. p. 153–66.

24. European Centre for Disease Prevention and Control. Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA 2014:40–8.

25. Urbanus AT, van de Laar Thijs J W, van den Hoek A, Zuure FR, Speksnijder Adrianus G C L, Baaten GGG et al. Hepatitis C in the general population of various ethnic origins living in the Netherlands: should non-Western migrants be screened? J Hepatol 2011; 55(6):1207–14. doi: 10.1016/j.jhep.2011.02.028 21703202

26. Stronks K, Ravelli AC, Reijneveld SA. Immigrants in the Netherlands: equal access for equal needs? J Epidemiol Community Health 2001; 55(10):701–7. doi: 10.1136/jech.55.10.701 11553652

27. Stirbu I, Kunst AE, Bos V, Mackenbach JP. Differences in avoidable mortality between migrants and the native Dutch in The Netherlands. BMC Public Health 2006; 6:78. doi: 10.1186/1471-2458-6-78 16566833

28. van Wieringen Joke C M, Harmsen JAM, Bruijnzeels MA. Intercultural communication in general practice. Eur J Public Health 2002; 12(1):63–8. doi: 10.1093/eurpub/12.1.63 11968523

29. Harmsen H, Meeuwesen L, van Wieringen J, Bernsen R, Bruijnzeels M. When cultures meet in general practice: intercultural differences between GPs and parents of child patients. Patient Educ Couns 2003; 51(2):99–106. 14572938

30. Rao K, Darrington DL, Schumacher JJ, Devetten M, Vose JM, Loberiza FR JR. Disparity in survival outcome after hematopoietic stem cell transplantation for hematologic malignancies according to area of primary residence. Biol Blood Marrow Transplant 2007; 13(12):1508–14. doi: 10.1016/j.bbmt.2007.09.006 18022581

31. Goldberg DS, French B, Forde KA, Groeneveld PW, Bittermann T, Backus L et al. Association of distance from a transplant center with access to waitlist placement, receipt of liver transplantation, and survival among US veterans. JAMA 2014; 311(12):1234–43. doi: 10.1001/jama.2014.2520 24668105

32. DuBay DA, MacLennan PA, Reed RD, Shelton BA, Redden DT, Fouad M et al. Insurance Type and Solid Organ Transplantation Outcomes: A Historical Perspective on How Medicaid Expansion Might Impact Transplantation Outcomes. J Am Coll Surg 2016; 223(4):611–620.e4. doi: 10.1016/j.jamcollsurg.2016.07.004 27457252

33. Ridic G, Gleason S, Ridic O. Comparisons of health care systems in the United States, Germany and Canada. Mater Sociomed 2012; 24(2):112–20. doi: 10.5455/msm.2012.24.112-120 23678317

34. Sarpel U, Suprun M, Sofianou A, Berger Y, Tedjasukmana A, Sekendiz Z et al. Disentangling the effects of race and socioeconomic factors on liver transplantation rates for hepatocellular carcinoma. Clin Transplant 2016; 30(6):714–21. doi: 10.1111/ctr.12739 27027869

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2019 Číslo 10