Reduction in racial and ethnic disparity in survival following liver transplant for hepatocellular carcinoma in DAA era. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Shaikh, A., Goli, K., Lee, T., Rich, N. E., Benhammou, J. N., Keeling, S., Kim, D., Ahmed, A., Goss, J., Rana, A., Singal, A. G., Kanwal, F., Cholankeril, G. 2022


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