Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma

Bodek, Daniel; Everwine, Matthew; Lunsford, Keri E.; Okoronkwo, N. O.; Patel, Pavan; Pyrsopoulos, Nikolaos

doi:10.1097/mcg.0000000000001675

“…Despite NHB patients showing lower inpatient mortality rates for AH, we noted a lower rate of liver transplants within this demographic. Our study supports previous ndings from various transplant databases (30)(31)(32) and underscores disparities rooted in multifaceted factors. Firstly, there is a noted variation in the severity of alcohol-related liver injury and recovery among racial groups, with NHB individuals potentially experiencing milder AH compared to NHW (26).…”

Section: Discussionsupporting

confidence: 91%

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Pan,

Guifarro,

Poudel

et al. 2024

Dig Dis Sci

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Introduction:Alcoholic Hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. Methods:We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identi ed using speci c ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. Results:Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. Conclusion:Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These ndings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes.In the United States, excessive alcohol consumption ranks as the third leading cause of preventable death. Surveys indicate that 68% of American adults consume alcohol monthly, with 10% classi ed as heavy drinkers (3,4). AH's incidence is challenging to determine due to asymptomatic cases, but studies suggest a prevalence of 20-35% among alcohol consumers. With an estimated 8% of Americans suffering from alcoholism, this translates to approximately 26.6 million individuals at risk for AH, potentially resulting in 5.3-9.3 million AH cases (4).The management of AH remains a signi cant medical challenge, with steroids as the primary treatment. However, these treatments do not substantially reduce the long-term mortality rates (5-7). The risk of developing AH varies with the amount and duration of alcohol consumption, indicating the interplay of environmental, genetic, and sociodemographic factors in the disease development (7). Despite recent efforts to equalize healthcare access across racial and ethnic groups for chronic liver disease, the impact of these efforts on AH remains to be examined (8,9). Therefore, our study aims to analyze the mortality and morbidity of AH across racial groups and employ forecasting methods to project hospitalization trends up to 2028. This will aid ...

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“…Despite NHB patients showing lower inpatient mortality rates for AH, we noted a lower rate of liver transplants within this demographic. Our study supports previous ndings from various transplant databases (30)(31)(32) and underscores disparities rooted in multifaceted factors. Firstly, there is a noted variation in the severity of alcohol-related liver injury and recovery among racial groups, with NHB individuals potentially experiencing milder AH compared to NHW (26).…”

Section: Discussionsupporting

confidence: 91%

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Pan,

Guifarro,

Poudel

et al. 2024

Preprint

0

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Introduction: Alcoholic Hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. Methods: We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identified using specific ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. Results: Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. Conclusion: Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These findings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes.

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“…Although it is well documented that Black LT candidates with HCC face a significantly lower probability of LT, 4,23–26 our study of 2017–2021 data shows no differences in the cumulative incidence of LT or waitlist removal among Black patients with HCC when compared to White patients with HCC. While this finding may be surprising, the lack of disparity between these two groups could be explained in several ways.…”

Section: Discussioncontrasting

confidence: 63%

Racial–ethnic differences in liver transplant waitlist outcomes in patients with hepatocellular carcinoma before and after recent changes to allocation policy

Mazur,

Cron,

Goldberg

et al. 2024

Clinical Transplantation

2

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BackgroundIn May 2019, liver transplant (LT) allocation policy changed to limit MELD exception points for hepatocellular carcinoma (HCC) to median MELD at transplant minus three (MMaT‐3). We evaluated this policy's impact on waitlist outcomes for HCC candidates, by race and ethnicity, hypothesizing that the introduction of the MMaT‐3 reduced inequities in waitlist outcomes.MethodsRetrospective cohort study of the Scientific Registry for Transplant Recipients, including all adult LT candidates (N = 10 751) who received HCC exception points from May 17, 2017 to May 18, 2019 (pre‐policy; N = 6627) to May 19, 2019 to March 1, 2021 (post‐policy; N = 4124). We compared incidence of LT and waitlist removal for death or becoming too sick pre‐ and post‐policy for non‐Hispanic White, non‐Hispanic Black, Hispanic/Latinx, and Asian patients using competing risk regression adjusted for candidate characteristics.ResultsOne‐year cumulative incidence of LT decreased significantly pre‐/post‐policy among White (77.4% vs. 64.5%; p < .01) and Black (76.2% vs. 63.1%; p < .01) candidates only, while a 1‐year incidence of death/non‐LT waitlist removal decreased significantly only among Hispanics (13.4% vs. 7.5%; p < .01). After covariate adjustment, the effect of the policy change was a significantly decreased incidence of LT for White (SHR: .63 compared to pre‐policy; p < .001), Black (SHR: .62; p < .001), and Asian (SHR: .68; p = .002), but no change for Hispanic patients. Only Hispanic patients had a significant decrease in death/waitlist removal after the policy change (SHR: .69; p = .04). Compared to White patients in the pre‐policy era, Hispanic (SHR: .88, p < .007) and Asian candidates (SHR: .72; p < .001) had lower unadjusted incidence of LT. This disparity was mitigated in the post‐policy era where Hispanic patients had higher likelihood of LT than Whites (SHR: 1.22; p = .002). For the outcome of death/non‐LT waitlist removal, the only significant difference was a 42% lower incidence of waitlist removal for Asian compared to White patients in the post‐policy era (SHR: .58; p = .03).ConclusionAmong LT recipients with HCC, racial/ethnic subpopulations were differentially affected by the MMAT‐3 policy, resulting in a post‐policy reduction of some of the previous disparities.

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Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma

Cited by 7 publications

References 29 publications

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Racial–ethnic differences in liver transplant waitlist outcomes in patients with hepatocellular carcinoma before and after recent changes to allocation policy

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