1Department of Surgery, Division of Surgical Oncology.
2Department of Population, Health Science and Policy.
3Department of Strategic Planning.
4Department of Neurosurgery.
5Ross University, Roseau, Dominica.
6The Recanati / Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, United States.
Liver transplantation is the most effective treatment for hepatocellular carcinoma (HCC) in eligible patients, but is not accessed equally by all. We explored the effects of race and socioeconomic factors on transplantation for HCC while controlling for stage, resection status, and transplant candidacy.
PATIENTS AND METHODS:
All HCC patients, 2003-2013, were retrospectively analyzed using multivariate analysis was used to explore differences in transplantation rates among cohorts.
Of 3,078 HCC patients, 754 (24%) were considered transplant eligible. Odds of transplantation were significantly higher for those with commercial insurance (OR=1.99, 95% CI [1.42, 2.79]) and lower for black patients (OR=0.55, 95% CI [0.33, 0.91]). Asians were more likely to be resected than white patients with similarly stage tumors and transplant criteria (p< 0.001). Patients not listed for transplantation for nonmedical reasons were more likely to be government-insured (p=0.02) and non-white (p=0.05). No step along the transplantation pathway was identified as the dominant hurdle.
Patients who are black or government-insured are significantly less likely to undergo transplantation for HCC despite controlling for tumor stage, resection status, and transplant eligibility. Asian patients have higher rates of hepatic resection, but also appear to have lower transplantation rates beyond this effect.