Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma

被引:8
作者
Huang, Dora C. [1 ]
Yu, Rosa L. [2 ]
Alqahtani, Saleh [3 ,4 ]
Tamim, Hani [4 ]
Saberi, Behnam [1 ]
Bonder, Alan [1 ]
机构
[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Gastroenterol & Hepatol, Boston, MA 02215 USA
[2] Beth Israel Deaconess Med Ctr, Dept Internal Med, Boston, MA USA
[3] Johns Hopkins Univ, Div Gastroenterol & Hepatol, Sch Med, Baltimore, MD USA
[4] Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia
关键词
Liver transplantation; Socioeconomic disparities; Hepatocellular carcinoma; Race and ethnicity; Share; 35; EPIDEMIOLOGY; MORTALITY; RATES; RACE;
D O I
10.1016/j.aohep.2023.101127
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction and Objectives: Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35. Materials and Methods: We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios. Results: Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower postLT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods. Conclusions: Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35. & COPY; 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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页数:7
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