The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma: Analysis of the National Inpatient Sample From 2007 to 2014
J Clin Gastroenterol. 2022 Feb 18. doi: 10.1097/MCG.0000000000001675. Online ahead of print.
Daniel D Bodek1, Matthew M Everwine, Keri E Lunsford, Nneoma Okoronkwo, Pavan A Patel, Nikolaos Pyrsopoulos
Departments of Gastroenterology Internal Medicine, Rowan University Medical School, Stratford Division of Liver Transplant and HPB Surgery, Department of Surgery and Center for Immunity and Inflammation Department of Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ.
Background: Hepatocellular carcinoma (HCC) remains a deadly disease, with patients' best hope for a cure being liver transplantation; however, access to health care resources, such as donor organs, between ethnic groups has historically been unbalanced. Ensuring equitable access to donor livers is crucial to minimize disparities in HCC outcomes. As a result, we sought to better elucidate the differences in transplantation rates among various ethnic groups.
Materials and methods: The National Inpatient Sample (NIS) was utilized to evaluate for disparities in liver transplantation in patients whose primary or secondary diagnosis was recorded as HCC or hepatoma. The study included admissions between 2007 and 2014 to centers with at least 1 documented liver transplant.
Results: A total of 7244 transplants were performed over 70,406 weighted admissions. Black race was associated with lower transplantation rates, with an adjusted odds ratio of 0.46 (95% confidence interval: 0.42-0.51, P<0.01) when accounting for a number of possible confounders including socioeconomic and geographic factors.
Conclusions: Our study observed decreased rates of liver transplant in blacks compared with whites for HCC. Furthermore, improved economic status and private insurance had a significantly higher odds ratio for transplantation. Hospital-level studies are needed to clarify confounding factors not apparent in large administrative datasets and help better investigate factors that lead to less optimal transplant rates among blacks. Interventions may include more optimal screening policies and procedures, improved interdisciplinary management, and earlier referrals.