Baker Brittany, Aridi Tarek G, Patel Meera, Carter Allie, Singleton Carolyn, Ross-Driscoll Katie, Orman Eric, Desai Archita P, Ghabril Marwan, Chalasani Naga, Kubal Shekhar, Holden John, Nephew Lauren D
Internal Medicine Residency, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Dig Dis Sci. 2025 Aug 6. doi: 10.1007/s10620-025-09278-3.
Hepatocellular carcinoma (HCC) is a serious consequence of chronic liver disease, with liver transplantation (LT) as the most durable curative option. However, significant disparities in access persist. Further, there is a lack of data on social determinants of health (SDOH) and disease-related barriers to HCC-LT pathway completion.
This retrospective cohort study included adults referred to a single center for LT with HCC from 2017 to 2021. SDOH exposures included race, ethnicity, gender, insurance type, area deprivation index (ADI), and marital status. Data from transplant database notes, including open-text fields documenting reasons for evaluation discontinuation, were used to identify and categorize reasons for failure to complete six predefined steps in the HCC-LT pathway. Multivariable logistic regression and competing risk analysis evaluated factors associated with waitlisting and survival.
Among 495 HCC patients referred for LT, 8.7% were Black and 57.2% were insured by Medicaid, with a mean ADI of 69.0 (± 21.1). Disease-related barriers (39.0%) and social barriers (35.6%) were common reasons for failing to complete the LT pathway. Public insurance (aOR 0.65, 95% CI 0.44-0.95) and being unmarried (aOR 0.60, 95% CI 0.40-0.88) were independently associated with a lower odd of waitlisting, and high ADI (aHR 1.01, 95% CI 1.00-1.02) was associated with mortality.
Insurance type and marital status were associated with a failure to waitlist and ADI with survival. The SDOH were important barriers to completing the HCC-LT pathway. Targeted interventions are needed to support at-risk patients through the HCC-LT process.
肝细胞癌（HCC）是慢性肝病的严重后果，肝移植（LT）是最持久的治愈选择。然而，在获取肝移植方面仍存在显著差异。此外，缺乏关于健康的社会决定因素（SDOH）以及影响肝癌肝移植流程完成的疾病相关障碍的数据。
这项回顾性队列研究纳入了2017年至2021年转诊至单一中心进行肝癌肝移植的成年人。SDOH暴露因素包括种族、民族、性别、保险类型、地区贫困指数（ADI）和婚姻状况。移植数据库记录中的数据，包括记录评估终止原因的开放文本字段，用于识别和分类未能完成肝癌肝移植流程中六个预定义步骤的原因。多变量逻辑回归和竞争风险分析评估了与列入等待名单和生存相关的因素。
在495例转诊进行肝移植的肝癌患者中，8.7%为黑人，57.2%由医疗补助保险承保，平均ADI为69.0（±21.1）。疾病相关障碍（39.0%）和社会障碍（35.6%）是未能完成肝移植流程的常见原因。公共保险（调整后比值比[aOR]为0.65，95%置信区间[CI]为0.44 - 0.95）和未婚（aOR为0.60，95%CI为0.40 - 0.88）与列入等待名单的较低几率独立相关，高ADI（调整后风险比[aHR]为1.01，95%CI为1.00 - 1.02）与死亡率相关。
保险类型和婚姻状况与未能列入等待名单相关，而ADI与生存相关。SDOH是完成肝癌肝移植流程的重要障碍。需要有针对性的干预措施，以在肝癌肝移植过程中支持高危患者。
