Language
English
Publication Date
9-18-2025
Journal
World Journal of Transplantation
DOI
10.5500/wjt.v15.i3.101997
PMID
40881754
PMCID
PMC12038589
PubMedCentral® Posted Date
9-18-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly common, as is hepatocellular carcinoma (HCC) in the background of MASH. Liver transplantation (LT) provides superior long-term survival for patients with unresectable MASH-HCC, but not all patients have equal access to transplant. MASH-HCC disproportionately affects Hispanic patients, but minorities are less likely to undergo LT for HCC. Additionally, females also undergo LT at lower rates than males.
Aim: To investigate whether race/ethnicity and sex affect LT waitlist outcomes.
Methods: Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.
Results: Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic (NH) white (71.2%) or Hispanic (23.4%), with only 49 (1.1%) NH Black candidates. Hispanics underwent LT at lower rates than NH whites (71.6% vs 78.4%, P < 0.001), but race/ethnicity did not affect waitlist mortality (P = 0.06). Patients with Hispanic [hazard ratio (HR) = 0.85, 95%CI: 0.77-0.95, P = 0.002] or Asian (HR = 0.79, 95%CI: 0.63-0.98, P = 0.04) race/ethnicity were less likely to undergo LT. Women were also less likely to receive LT (male: HR = 1.16, 95%CI: 1.04-1.29, P = 0.01). Patients in regions 1 and 9 were less likely to be transplanted as well (P = 0.07).
Conclusion: Hispanic patients are less likely to undergo LT for MASH-HCC, concerning given their susceptibility to MASH and HCC. There were very few NH Black candidates. Disparities were also unequal across regions, which is particularly concerning in states where at-risk populations have rising cancer incidence. Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.
Keywords
Steatotic liver disease, Liver neoplasms, Ethnic and racial minorities, Healthcare disparities, Minority health
Published Open-Access
yes
Recommended Citation
Victor, David W; Kodali, Sudha; Noureddin, Mazen; et al., "Disparities in Liver Transplantation for Metabolic Dysfunction-Associated Steatohepatitis-Associated Hepatocellular Carcinoma" (2025). Faculty and Staff Publications. 5686.
https://digitalcommons.library.tmc.edu/baylor_docs/5686
Included in
Allergy and Immunology Commons, Biological Phenomena, Cell Phenomena, and Immunity Commons, Pathology Commons