Reduction in Racial and Ethnic Disparity in Survival Following Liver Transplant for Hepatocellular Carcinoma in the Direct-acting Antiviral Era

Authors

Anjiya Shaikh
Karthik Goli
Tzu-Hao Lee
Nicole E Rich
Jihane N Benhammou
Stephanie Keeling
Donghee Kim
Aijaz Ahmed
John Goss
Abbas Rana
Amit G Singal
Fasiha Kanwal
George Cholankeril

Publication Date

8-1-2023

Journal

Clinical Gastroenterology and Hepatology

DOI

10.1016/j.cgh.2022.11.038

PMID

36521738

PMCID

PMC10686256

PubMedCentral® Posted Date

8-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Carcinoma, Hepatocellular, Antiviral Agents, Liver Transplantation, Liver Neoplasms, Hepatitis C, Chronic, Retrospective Studies, Hepatitis C, Hepacivirus, Race/racial, Equity, Black/African-American, Hispanic/Latinx, Disparities, Equity, Diverse/Diversity, Liver cancer, Transplant, HCV treatment, Direct acting antiviral therapy

Abstract

BACKGROUND & AIMS: Black patients with hepatocellular cancer (HCC), often attributed to hepatitis C virus (HCV) infection, have suboptimal survival following liver transplant (LT). We evaluated the impact of direct-acting antiviral (DAA) availability on racial and ethnic disparities in wait list burden post-LT survival for candidates with HCC.

METHODS: Using the United Network for Organ Sharing registry, we identified patients with HCC who were listed and/or underwent LT from 2009 to 2020. Based on date of LT, patients were categorized into 2 era-based cohorts: the pre-DAA era (LT between 2009 and 2011) and DAA era (LT between 2015 and 2017, with follow-up through 2020). Kaplan-Meier and Cox proportional hazards analyses were used to compare post-LT survival, stratified by era and race and ethnicity.

RESULTS: Annual wait list additions for HCV-related HCC decreased significantly in White and Hispanic patients during the DAA era, with no change (P = .14) in Black patients. Black patients had lower 3-year survival than White patients in the pre-DAA era (70.6% vs 80.1%, respectively; P < .001) but comparable survival in the DAA era (82.1% vs 85.5%, respectively; P = .16). 0n multivariable analysis, Black patients in the pre-DAA era had a 53% higher risk (adjusted hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.28-1.84), for mortality than White patients, but mortality was comparable in the DAA era (adjusted HR, 1.23; 95% CI, 0.99-1.52). In a stratified analysis in Black patients, HCV-related HCC carried more than a 2-fold higher risk of mortality in the pre-DAA era (adjusted HR, 2.86; 95% CI, 1.50-5.43), which was reduced in the DAA era (adjusted HR, 1.34; 95% CI, 0.78-2.30).

CONCLUSIONS: With the availability of DAA therapy, racial disparities in post-LT survival have improved.

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