Following a policy change in liver transplant rules, rates of transplantation to treat liver cancer have fallen across all racial groups. But Black individuals experience the worst outcomes, including a high mortality rate, according to study findings published in JAMA Network Open.
Over time, hepatitis B, hepatitis C, steatotic liver disease and other causes can lead to liver cirrhosis and an elevated risk for hepatocellular carcinoma (HCC), the most common type of liver cancer. HCC is often diagnosed late and is difficult to treat. Once liver failure occurs, a liver transplant may be the only remaining option.
Between 2002 and 2015, the Organ Procurement and Transplantation Network policy allowed more people with liver cancer to receive transplants. In 2015, the policy was changed to institute a six-month delay based on points assigned using the Model for End-Stage Liver Disease (MELD) scoring system.
Behnam Saberi, MD, of Harvard Medical School, and colleagues looked at potential racial disparities in transplantation for people with liver cancer and related mortality after this policy change. Previous research has shown that Black and Latino individuals face greater barriers to liver transplantation.
For this retrospective study, the researchers used data from the United Network Organ Sharing/Organ Procurement Transplant Network. The database included information on people with hepatocellular carcinoma on the liver transplant waiting list as well as liver transplant recipients from 2003 to 2021. The wait-listed population included 12,031 people with HCC. Three quarters were men, the average age was 61 years, 60% were white, 22% were Latino and 10% were Black.
After the policy change, liver transplant rates for HCC decreased across all racial and ethnic groups. However, the overall rate of dropouts from the waiting list remained unchanged.
While more Black people dropped off the waiting list before the policy change, the dropout rates of Black, Latino and white patients were comparable after the change. Before and after the policy change, Black people continued to experience a higher risk of mortality after a liver transplant compared with white people. Asians had the lowest dropout rate and the highest survival rate following transplantation before and after the policy change.
“This cohort study of liver transplant candidates in the U.S. found that after the 2015 MELD exception policy change for HCC, the proportion of liver transplants for HCC had decreased for all races,” wrote the researchers. “Black or African-American patients had worse outcomes after liver transplant than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC liver transplant candidates.”
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