The closing survival gap after liver transplantation for hepatocellular carcinoma in the United States

Líu, Hao; Kaltenmeier, Christof; Jonassaint, Naudia; Behari, Jaideep; Duarte‐Rojo, Andrés; Malik, Shahid M.; Hughes, Dempsey L; Ganesh, Swaytha; Reddy, Dheera; Powers, Colin; Lizeth, Caitlin; Thompson, Ann; Harakeh, Hasan Al; Hill, Roy; Zhang, Xingyu; Diego, Emilia; Martini, Andréa; Bataller, Ramón; Molinari, Michele

doi:10.1016/j.hpb.2022.07.008

Cited by 2 publications

(3 citation statements)

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“…Our multivariable models reveal that Black or African American patients had the lowest survival after LT, regardless of HCC status and across both eras. These findings align with a former UNOS study that analyzed data until 2017, 19 but that study additionally reported a decreasing difference over time, which is not seen in our study after 2015. It is unclear why Black or African American patients have the highest mortality after transplant, irrespective of the era.…”

Section: Discussionsupporting

confidence: 93%

“…Attributing the decline in LT rates and higher dropout rates for patients with HCC solely to the 2015 MELD exception policy change is challenging. Our results suggest that specific and increasing barriers faced by minoritized populations are not effectively addressed by current policies and should be the focus of future studies . We hypothesize that Asian patients show the lowest dropout and higher survival rate because they have more HBV, the lowest MELD scores, and were not as often decompensated.…”

Section: Discussionmentioning

confidence: 90%

“…Our results suggest that specific and increasing barriers faced by minoritized populations are not effectively addressed by current policies and should be the focus of future studies. 19,22 We hypothesize that Asian patients show the lowest dropout and higher survival rate because they have more HBV, the lowest MELD scores, and were not as often decompensated. But underlying causes of marked differences in survival after LT for all racial groups are likely due to social determinants of health.…”

Section: Discussionmentioning

confidence: 99%

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Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change

Saberi,

Gurakar,

Tamim

et al. 2023

JAMA Netw Open

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ImportanceRacial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment.ObjectiveTo quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors.Design, Setting, and ParticipantsThis cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021. Participants were adult patients with HCC on the LT waiting list and those who received LT. Data were analyzed from March 2022 to September 2023.ExposuresRace and time before and after the 2015 OPTN policy change.Main Outcomes and MeasuresProportion of LT from wait-listed candidates, the proportion of waiting list removals, and mortality after LT.ResultsAmong 12 031 patients wait-listed for LT with HCC (mean [SD] age, 60.8 [7.4] years; 9054 [75.3%] male; 7234 [60.1%] White, 2590 [21.5%] Latinx/o/a, and 1172 [9.7%] Black or African American), this study found that after the 2015 model of end-stage liver disease (MELD) exception policy changes for HCC (era 2), the overall proportion of LT for HCC across all races decreased while the proportion of dropouts on the LT waiting list remained steady compared with patients who did not have HCC. In Kaplan-Meier analysis, Asian patients demonstrated the lowest dropout rates in both era 1 and era 2 (1-year dropout, 16% and 17%, respectively; P &lt; .001). In contrast, Black or African American patients had the highest dropout rates in era 1 (1-year dropout, 24%), but comparable dropout rates (23%) with White patients (23%) and Latinx/o/a patients in era 2 (23%). In both eras, Asian patients had the highest survival after LT (5-year survival, 82% for era 1 and 86% for era 2), while Black or African American patients had the worst survival after LT (5-year survival, 71% for era 1 and 79% for era 2). In the multivariable analysis for HCC LT recipients, Black or African American race was associated with increased risk of mortality in both eras, compared with White race (HR for era 1, 1.17; 95% CI, 1.05-1.35; and HR for era 2, 1.31; 95% CI, 1.10-1.56).Conclusions and RelevanceThis cohort study of LT candidates in the US found that after the 2015 MELD exception policy change for HCC, the proportion of LT for HCC had decreased for all races. Black or African American patients had worse outcomes after LT than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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