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 antivirals (DAA) availability on racial and ethnic disparities in wait list burden post-LT survival for HCC candidates.METHODS: Using the United Network for Organ Sharing (UNOS) registry, we identified HCC patients who were listed and/or underwent LT from 2009 to 2020. Based on date of LT, patients were categorized into two era-based cohorts: the pre-DAA era (LT between 2009-2011) and DAA era (LT between 2015-2017, with follow-up through 2020). Kaplan Meir 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=0.14) 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<0.001) but comparable survival in the DAA era (82.1%, vs. 85.5%, respectively, P= 0.16). 0n multivariable analysis, Black patients in the pre-DAA era had a 53% higher risk (adjusted HR, 1.53, 95% CI:1.28-1.84), for mortality than White patients, but mortality was comparable in the DAA era (aHR, 1.23, 95% CI:0.99-1.52). In a stratified analysis in Black patients, HCV-related HCC carried more than a two-fold higher risk of mortality in the pre-DAA era (aHR 2.86, 95% CI:1.50-5.43) which was reduced in DAA era (aHR 1.34, 95%CI:0.78-2.30).CONCLUSIONS: With the availability of DAA therapy, racial disparities in post-LT survival have improved.

View details for DOI 10.1016/j.cgh.2022.11.038

View details for PubMedID 36521738