Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Ann Hepatol. 2023 Sep-Oct;28(5):101127. doi: 10.1016/j.aohep.2023.101127. Epub 2023 Jun 5.
Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35.
We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios.
Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower post-LT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods.
Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35.
肝移植可为肝细胞癌 (HCC) 患者提供治愈性治疗；然而，HCC 的发病率和死亡率因社会经济地位、种族和民族而异。为确保公平获得器官移植，实施了 Share 35 等政策；然而，其影响尚不清楚。我们旨在描述在考虑种族、民族、收入和保险类型时，HCC 患者在肝移植 (LT) 后生存的差异，并了解这些关联是否受 Share 35 影响。
我们对 30610 名接受 HCC 肝移植的成年患者进行了回顾性队列研究。数据来自 UNOS 数据库。使用 Kaplan-Meier 曲线进行生存分析，使用多变量 Cox 回归分析计算危险比。
男性 (HR：0.90(95%CI：0.85-0.95))、私人保险 (HR：0.91(95%CI：0.87-0.92)) 和收入 (HR：0.87(95%CI：0.83-0.92))，在调整了 20 多项人口统计学和临床特征后，与 LT 后生存率提高相关 (表 2)。与白人相比，非裔或黑人个体的 LT 后生存率较低 (HR：1.20(95%CI：1.12-1.28))，而亚裔 (HR：0.79(95%CI：0.71-0.88)) 或西班牙裔 (HR：0.86(95%CI：0.81-0.92)) 个体的生存率较高 (表 2)。这些模式在 Share 35 之前和之后的时期都存在。
移植时的种族、民族和社会经济差异，如私人保险和收入，影响 HCC 患者的 LT 后生存率。尽管通过了公平获取政策，如 Share 35，但这些模式仍然存在。
