Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden

Dakhoul, Lara; Gawrieh, Samer; Jones, Keaton R.; Ghabril, Marwan; McShane, Chelsey; Orman, Eric S.; Vilar‐Gomez, Eduardo; Chalasani, Naga; Nephew, Lauren

doi:10.1002/hep4.1277

Cited by 31 publications

(27 citation statements)

References 20 publications

(44 reference statements)

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“…However, prior studies show that Black patients with HCC were nearly 50% less likely to be transplanted than White patients. ( 26,27 ) Additionally, our multivariable analysis demonstrates that the transplant to listing ratio is not significantly different for any race/ethnicity. In contrast, Hispanic patients, who were more frequently listed than White patients, had the lowest likelihood of being transplanted while on the waitlist, again, while acknowledging that this was not borne out in multivariable analysis.…”

Section: Discussionmentioning

confidence: 73%

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

et al. 2021

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BaCKgRoUND aND aIMS:The Model for End-Stage Liver Disease score may have eliminated racial disparities on the waitlist for liver transplantation (LT), but disparities prior to waitlist placement have not been adequately quantified. We aimed to analyze differences in patients who are listed for LT, undergo transplantation, and die from end-stage liver disease (ESLD), stratified by state and race/ethnicity. appRoaCH aND ReSUltS: We analyzed two databases retrospectively, the Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) and the United Network for Organ Sharing (UNOS) databases, from 2014 to 2018. We included patients aged 25-64 years who had a primary cause of death of ESLD and were listed for transplant in the CDC WONDER or UNOS database. Our primary outcome was the ratio of listing for LT to death from ESLD-listing to death ratio (LDR). Our secondary outcome was the transplant to listing and transplant to death ratios. Chi-squared and multivariable linear regression evaluated for differences between races/ethnicities. There were 135,367 patients who died of ESLD, 54,734 patients who were listed for transplant, and 26,571 who underwent transplant. Patients were mostly male and White. The national LDR was 0.40, significantly lowest in Black patients (0.30), P < 0.001. The national transplant to listing ratio was 0.48, highest in Black patients (0.53), P < 0.01. The national transplant to death ratio was 0.20, lowest in Black patients (0.16), P < 0.001. States that had an above-mean LDR had a lower transplant to listing ratio but a higher transplant to death ratio. Multivariable analysis confirmed that Black race is significantly associated with a lower LDR and transplant to death ratio.CoNClUSIoNS: Black patients face a disparity in access to LT due to low listing rates for transplant relative to deaths from ESLD.

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Section: Discussionmentioning

confidence: 73%

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

et al. 2021

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“…Cirrhosis is a major risk factor for the development of HCC and about 80% of patients with HCC have liver cirrhosis . A diverse safety‐net hospital population study in United States reported that cirrhosis patients were associated with 29.9% HCV, 13.4% HBV, 44.6% alcoholic cirrhosis and 8.9% nonalcoholic steatohepatitis (NASH) .…”

Section: Cirrhosismentioning

confidence: 99%

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

et al. 2020

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Despite improved screening and surveillance guidelines, significant race/ethnicity‐specific disparities in hepatocellular carcinoma (HCC) continue to exist and disproportionately affect minority and disadvantaged populations. This trend indicates that social determinants, genetic, and environmental factors are driving the epidemic at the population level. Race and geography had independent associations with risk of mortality among patients with HCC. The present review discusses the risk factors and issues related to disparities in HCC. The underlying etiologies for these disparities are complex and multifactorial. Some of the risk factors for developing HCC include hepatitis B (HBV) and hepatitis C (HCV) viral infection, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, smoking and alcohol consumption. In addition, population genetics; socioeconomic and health care access; treatment and prevention differences; and genetic, behavioral, and biological influences can contribute to HCC. Acculturation of ethnic minorities, insurance status, and access to health care may further contribute to the observed disparities in HCC. By increasing awareness, better modalities for screening and surveillance, improving access to health care, and adapting targeted preventive and therapeutic interventions, disparities in HCC outcomes can be reduced or eliminated.

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“…17 Additionally, Black patients are less likely to receive a liver transplant, and studies have demonstrated that even in Black patients who receive treatment with a liver transplantation, survival is still less than patients of other races. [75][76][77]…”

Section: Individual-level Measures Race and Ethnicitymentioning

confidence: 99%

An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma

Kronenfeld

Goel

2021

JHC

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Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and affects patients of all genders, races, ethnicities, and socioeconomic status. While the causes of HCC are numerous, the primary etiology is cirrhosis from alcohol and non-alcoholic fatty liver disease in the United States and from infectious agents such as Hepatitis B and Hepatitis C in the developing world. In patients at-risk for developing HCC, screening is recommended with ultrasound imaging and alpha fetoprotein laboratory tests. In socioeconomically vulnerable patients, however, individual-level barriers (eg, insurance status) and contextual-level disparities (eg, health facilities) may not be readily available, thus limiting screening. Additional challenges faced by racial/ethnic minorities can further challenge the spectrum of HCC care and lead to inadequate screening, delayed diagnosis, and unequal access to treatment. Efforts to improve these multilevel factors that lead to screening and treatment disparities are critical to overcoming challenges. Providing health insurance to those without access, improving societal challenges that confine patients to a lower socioeconomic status, and reducing challenges to seeking healthcare can decrease the morbidity and mortality of these patients. Additionally, engaging with communities and allowing them to collaborate in their own healthcare can also help to attenuate these inequities. Through collaborative multidisciplinary change, we can make progress in tackling disparities in vulnerable populations to achieve health equity

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Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden

Cited by 31 publications

References 20 publications

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma

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