Racial and ethnic disparities in post–liver transplant survival among patients with hepatocellular carcinoma in the United States.

Authors

null

Udhayvir Singh Grewal

University of Iowa Hospitals and Clinics, Iowa City, IA

Udhayvir Singh Grewal, Apoorva K Chandar, Abdul Rahman Al Armashi, Akram Alkrekshi, Shiva Jashwanth Gaddam, Subhash C Garikipati

Organizations

University of Iowa Hospitals and Clinics, Iowa City, IA, University Hospitals Cleveland Medical Center, Cleveland, OH, Seidman Cancer Center/Case Cancer Comprehensive Center, Cleveland, OH, Metro Health Medical Center, Cleveland, OH, Feist-Weiller Cancer Center at LSUHSC-Shreveport, Shreveport, LA, Virginia Tech Carillion Clinic, Roanoke, VA

Research Funding

No funding received
None.

Background: Liver transplantation (LT) is a potentially curative treatment option for some patients with early-stage hepatocellular carcinoma (HCC). Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. However, real-world data on disparities in post-LT survival among patients with HCC are lacking. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 health care organizations in the United States, to retrospectively identify patients who had an ICD-10 diagnosis of HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47135, 47140, 47140, 47141, 47142) from 2012-2022. We retrieved data on baseline characteristics and compared them across racial and ethnic subgroups; Caucasians, African Americans (AA) and other minorities (Hispanics/Asians). We studied post-LT outcomes using survival at 1 year, 3 years and 5 years. Results: A total of 2,901 patients with HCC underwent LT over the study period, out of which, majority were Caucasians (2403/2901, 84.8%), followed by AA (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At baseline, AA patients had higher prevalence of viral hepatitis B (10.1% vs 5.7%, p=0.004), hepatitis C (72.7% vs 47.1%, p<0.001) and lower prevalence of alcoholic liver disease (36.3% vs 45.5%, p=0.004) as compared to Caucasian patients. Hispanic/Asian patients had lower prevalence of alcoholic liver disease (37.7% vs 45.5%, p=0.02), nicotine dependence (13.4% vs 21.3%, p=0.004) and higher prevalence of viral hepatitis B (24.7% vs 5.7%, p<0.001) as compared to Caucasian patients. We found no differences post-LT survival at 1 year (92.9% vs 91.6%, p=0.60), 3 years (77.6% vs 80.5%, p=0.48) and 5 years (71.0% vs 72.3%, p=0.46) between AA and Caucasian patients. While post-LT survival at 1 year was lower among Hispanic/Asian patients (88.5% vs 94.3%, p=0.04), we found no difference in post-LT survival at 3 years (82.5% vs 85.4%, p=0.27) and 5 years (75.8% vs 75.7%, p=0.55) when compared to Caucasians. Conclusions: We present real-world data demonstrating the under-representation of racial minorities in the cohort of patients with HCC receiving LT in the US. We found no differences in post-LT survival (except higher early mortality among Hispanic/Asian patients), across racial/ethnic groups. These results show that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC.

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Health Care Access, Equity, and Disparities,Technology and Innovation in Quality of Care,Palliative and Supportive Care

Sub Track

Cancer Outcome Disparities

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 178)

DOI

10.1200/OP.2023.19.11_suppl.178

Abstract #

178

Poster Bd #

E17

Abstract Disclosures