TY - JOUR
T1 - Reduction in Racial and Ethnic Disparity in Survival Following Liver Transplant for Hepatocellular Carcinoma in the Direct-acting Antiviral Era
AU - Shaikh, Anjiya
AU - Goli, Karthik
AU - Lee, Tzu Hao
AU - Rich, Nicole E.
AU - Benhammou, Jihane N.
AU - Keeling, Stephanie
AU - Kim, Donghee
AU - Ahmed, Aijaz
AU - Goss, John
AU - Rana, Abbas
AU - Singal, Amit G.
AU - Kanwal, Fasiha
AU - Cholankeril, George
N1 - Publisher Copyright:
© 2023 AGA Institute
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - Black/African-American
KW - Direct Acting Antiviral Therapy
KW - Disparities
KW - Diverse/Diversity
KW - Equity
KW - HCV treatment
KW - Hispanic/Latinx
KW - Liver Cancer
KW - Race/Racial
KW - Transplant
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U2 - 10.1016/j.cgh.2022.11.038
DO - 10.1016/j.cgh.2022.11.038
M3 - Article
C2 - 36521738
AN - SCOPUS:85146669421
SN - 1542-3565
VL - 21
SP - 2288-2297.e4
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 9
ER -