Impact of geographic disparity on liver allocation for hepatocellular cancer in the United States

Kadry, Zakiyah; Schaefer, Eric; Uemura, Tadahiro; Shah, Ali Riaz; Schreibman, Ian; Riley, Thomas

doi:10.1016/j.jhep.2011.08.019

Cited by 31 publications

(34 citation statements)

References 14 publications

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“…Candidates with HCC are at increased risk of tumor progression and waitlist dropout. [38] Once transplanted tumor relapse becomes an important mechanism of post-transplant mortality. However, locoregional therapies that inhibit tumor progression [39] might advantage HCC patients under current liver allocation policy, particularly in non-competitive donor service areas.…”

Section: Risk Assessmentmentioning

confidence: 99%

Quality of life, risk assessment, and safety research in liver transplantation

Butt

Parikh

Skaro

et al. 2012

Current Opinion in Organ Transplantation

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Purpose of review In this review, we briefly summarize three fruitful, emerging areas in liver transplantation research: quality of life; risk assessment; and patient safety. Our goal is to highlight recent findings in these areas, with a call for increased integration of social scientists and transplant clinicians to address how best to shape policy and improve outcomes. Recent findings After liver transplantation, recipients generally experience clinically significant, sustained improvement in their physical, social and emotional well-being. However, a sizeable minority of patients do experience excess morbidity that may benefit from ongoing surveillance and/or intervention. There is growing body of research that describes risks associated with liver transplantation, which can be useful aids to better inform decision making by patients, clinicians, payers, and policy makers. In contrast, there has been a relative lack of empirical data on transplant patient safety vulnerabilities, placing the field of surgery in stark contrast to other high risk industries, where such assessments inform continuous process improvement. Summary Health services and outcomes research has grown in importance in the liver transplantation literature, but several important questions remain unanswered that merit programmatic, interdisciplinary research.

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Section: Risk Assessmentmentioning

confidence: 99%

Quality of life, risk assessment, and safety research in liver transplantation

Butt

Parikh

Skaro

et al. 2012

Current Opinion in Organ Transplantation

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“…13,19 Most previous national database studies assessing waitlist dropout have had a very short median waitlist follow-up period of only 3-6 months. A major problem has been the relatively short wait time to LT in many parts of the country, leading to significant regional differences in dropout rates.…”

Section: Introductionmentioning

confidence: 99%

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation

Mehta

Dodge

Hirose

et al. 2019

American Journal of Transplantation

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All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT).A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Probabilities of waitlist dropout were 18.3% at 1 year and 27% at 2 years. In multivariate analysis, factors associated with a lower risk of waitlist dropout included Model for End-Stage Liver Disease-Na < 15, Child's class A, single 2-to 3-cm lesion, and α-fetoprotein ≤20 ng/mL. The subgroup of 245 (11.9%) patients meeting these 4 criteria at LT listing had a 1-year probability of dropout of 5.5% vs 20% for all others (P < .001). On explant, the low dropout risk group was more likely to have complete tumor necrosis (35.5% vs 24.9%, P = .01) and less likely to exceed Milan criteria (9.9% vs 17.7%, P = .03). We identified a subgroup with a low risk of waitlist dropout who should not receive the same LT listing priority. K E Y W O R D Sclinical research/practice, health services and outcomes research, liver disease malignant, liver transplantation/hepatology, organ allocation, organ procurement and allocation, Organ Procurement and Transplantation Network (OPTN), recipient selection, United Network for Organ Sharing (UNOS)

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“…African Americans and Asian/Pacific Islanders are less likely to receive a liver transplant for HCC than White patients [7]. Differences in access to liver transplant have also been reported depending on insurance status, geography, and income status [8–10]. The purpose of this study is to delve more deeply into the reason for disparities in access to liver transplant for patients with HCC.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Factors Affect Disparities in Access to Liver Transplant for Hepatocellular Cancer

Hernandez

Albright

2012

Journal of Transplantation

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Objective. The incidence/death rate of hepatocellular cancer (HCC) is increasing in America, and it is unclear if access to care contributes to this increase. Design/Patients. 575 HCC cases were reviewed for demographics, education, and tumor size. Main Outcome Measures. Endpoints to determine access to HCC care included whether an eligible patient underwent liver transplantation. Results. Transplant patients versus those not transplanted were younger (55.7 versus 61.8 yrs, P < 0.001), males (89.3% versus 74.4%, P = 0.013), and having completed high school (10.1% versus 1.2%, P = 0.016). There were differences in transplant by ethnicity, insurance, and occupation. Transplant patients with HCC had higher median income via census classification ($54,383 versus $49,383, P = 0.046) and self-reported income ($48,948 versus $38,800, P = 0.002). Differences in access may be related to exclusion criteria for liver transplant, as Pacific Islanders were more likely to have tumor size larger than 5 cm compared to Whites and have BMI > 35 (20.7%) compared to Whites (6.4%) and Asians (4.7%). Conclusions. Ethnic differences in access to transplant are associated with socioeconomic status and factors that can disqualify patients (advanced disease/morbid obesity). Efforts to overcome educational barriers and screening for HCC could improve access to transplant.

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Impact of geographic disparity on liver allocation for hepatocellular cancer in the United States

Cited by 31 publications

References 14 publications

Quality of life, risk assessment, and safety research in liver transplantation

Quality of life, risk assessment, and safety research in liver transplantation

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation

Socioeconomic Factors Affect Disparities in Access to Liver Transplant for Hepatocellular Cancer

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