Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma
Introduction and Objectives: Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268123002314 |
| _version_ | 1827856316953001984 |
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| author | Dora C. Huang Rosa L. Yu Saleh Alqahtani Hani Tamim Behnam Saberi Alan Bonder |
| author_facet | Dora C. Huang Rosa L. Yu Saleh Alqahtani Hani Tamim Behnam Saberi Alan Bonder |
| author_sort | Dora C. Huang |
| collection | DOAJ |
| description | Introduction and Objectives: Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35. Materials and Methods: We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios. Results: Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower post-LT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods. Conclusions: Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35. |
| first_indexed | 2024-03-12T12:24:03Z |
| format | Article |
| id | doaj.art-b441b3bd766946f783c7e74976f6c728 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-12T12:24:03Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-b441b3bd766946f783c7e74976f6c7282023-08-30T05:50:18ZengElsevierAnnals of Hepatology1665-26812023-09-01285101127Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinomaDora C. Huang0Rosa L. Yu1Saleh Alqahtani2Hani Tamim3Behnam Saberi4Alan Bonder5Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United StatesDepartment of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDivision of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, United States; College of Medicine, Alfaisal University, Riyadh, Saudi ArabiaCollege of Medicine, Alfaisal University, Riyadh, Saudi ArabiaDivision of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United StatesDivision of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Corresponding author.Introduction and Objectives: Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35. Materials and Methods: We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios. Results: Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower post-LT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods. Conclusions: Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35.http://www.sciencedirect.com/science/article/pii/S1665268123002314Liver transplantationSocioeconomic disparitiesHepatocellular carcinomaRace and ethnicityShare 35 |
| spellingShingle | Dora C. Huang Rosa L. Yu Saleh Alqahtani Hani Tamim Behnam Saberi Alan Bonder Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma Annals of Hepatology Liver transplantation Socioeconomic disparities Hepatocellular carcinoma Race and ethnicity Share 35 |
| title | Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma |
| title_full | Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma |
| title_fullStr | Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma |
| title_full_unstemmed | Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma |
| title_short | Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma |
| title_sort | racial ethnic and socioeconomic disparities impact post liver transplant survival in patients with hepatocellular carcinoma |
| topic | Liver transplantation Socioeconomic disparities Hepatocellular carcinoma Race and ethnicity Share 35 |
| url | http://www.sciencedirect.com/science/article/pii/S1665268123002314 |
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