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

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
StateAccepted/In press - 2023


  • Black/African-American
  • Direct Acting Antiviral Therapy
  • Disparities
  • Diverse/Diversity
  • Equity
  • HCV treatment
  • Hispanic/Latinx
  • Liver Cancer
  • Race/Racial
  • Transplant

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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