Black patients have higher mortality and are less likely to receive liver transplantation for hepatocellular carcinoma (HCC) than white patients. Reasons for these disparities have not been fully elucidated. Comorbid disease, liver disease severity, cirrhosis etiologies, and tumor characteristics were compared between black and white patients with HCC seen at the Indiana University Academic Medical Center from January 2000 to June 2014. Logistic regression was used to investigate the primary outcome, which was liver transplantation. Log‐rank testing was used to compare survival between the two groups. Subgroup analysis explored reasons for failure to undergo liver transplantation in patients within Milan criteria. The cohort included 1,032 (86%) white and 164 (14%) black patients. Black and white patients had similar Model for End‐Stage Liver Disease (MELD) and Child‐Pugh scores (CPSs). There was a trend toward larger tumor size (5.3 cm versus 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer (BCLC) staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients; this was a disparity that was not attenuated (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21‐0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation compared to white patients. Survival was similar between the two groups. Conclusion: Racial differences in patient and tumor characteristics were small and did not explain the disparity in liver transplantation. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity in this cohort.
Background: Hepatocellular carcinoma (HCC) is rare in patients with autoimmune hepatitis (AIH). However, the overall burden of AIH cirrhosis in causing HCC and patients' risk factors are not well understood. Aims: To characterize the proportion of HCC linked to AIH at a large academic health center, and to identify variables associated with HCC in patients with AIH in a case-control study design. Methods: Over a 14.5-year period, medical records of all patients with HCC were reviewed. Cases are AIH patients identified from the cohort and controls are patients with AIH without HCC. Three controls were randomly chosen from the Genetic Repository of Autoimmune Liver Disease and Coexisting Exposures database for each eligible case. Results: Out of 1,250 eligible patients, 20 were linked to AIH (1.6%). Their median age was 64 years, 40% men, and 100% Caucasian. 10% of AIH patients did not have evidence of cirrhosis at HCC diagnosis. The proportion of HCCs due to AIH decreased during the time intervals of the study. Compared to controls, cases were more likely men (40.0% vs. 18%, P=0.049), with longer AIH duration (median 16 years vs. 5 years, P=0.004). Prolonged AIH duration (OR 1.68, p=0.006) and older age (OR 1.15, p=0.049) were risk factors for HCC. Conclusions: AIH is a rare cause (1.6%) for HCC in Midwestern United States with a decreasing trend over 14.5 years. 10% of AIH-HCC patients occurs without cirrhosis. Patients with prolonged duration of the disease and older age are at high risk to develop HCC.
Methods: Group-A (Intervention) was prospectively enrolled in QI project database -during Jan 2019 to Dec 2021. We performed retrospective analysis of patients admitted with recurrent HE. 30-day and 60day liver-related hospitalizations were recorded for patients who had Rifaximin added during index hospitalization. Control (Group-B) was identified from historical readmission data at our center during November 1, 2018, to January 1, 2019, as patients who were written Rifaximin prescription at time of discharge, prior to initiation of our QI project. Results: 80 patients constituted Group A -23 received Rifaximin at the bedside (39% female) prior to discharge and 57 (19% female) received it within 30 days of discharge from hospitalization. 44 patients constituted Group-B. Proportion of patients readmitted within 30 days was lower in Group-A compared to Group-B (48% vs 73%; p50.002). In 60 days after discharge, proportion of Group-A patients needing readmission was 56% compared to 73% (p50.007). 12% of patients (n510) had no readmissions. Males had a 16% reduction in 30-day readmission, and 45% reduction in 60-day readmissions. Female patients had 52% reduction in 30-day readmission, and 75% reduction in 60-day readmission. African American, Caucasian, and Hispanic patients showed 11%, 33%, and 71% reduction in 30-day rehospitalization, and 59%, 53%, and 64% reduction in 60-day rehospitalizations (Table ). Conclusion: Proactively working on the insurance coverage and cost of payment incurred to the patients for Rifaximin at the time of hospital discharge will reduce early readmissions. Hospitals should utilize the opportunity during each hospitalization to alleviate disparities in admission caused by poor access to Rifaximin. Thus, providing equiTable healthcare to all patients who need Rifaximin for chronic control of recurrent symptoms of HE.
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