Ethnicity and Liver Transplantation in the Evolving HCV Landscape.

Abstract

In the last two decades, HCV-Cirrhosis has been the most common indication for liver transplantation (LT) in USA. However, recent HCV surveillance studies show decline in incidence of HCV infection in USA. The impact of this paradigm shift, on waiting list registration (WLR) for candidates with HCV is unknown. Therefore, the aim of this study is to investigate trends in new wait list registrations for HCV. Method: Using the UNOS database, we identified all adult (> 18 years) candidates added to LT waiting list during the study period (2002 - 2012). Data extracted included patient demographics (i.e. age, gender and ethnicity), liver diagnosis and MELD score. Ethnicity/Race was categorized as White, Black, Hispanic, Asian and others while Age was categorized into: (i) 18 - 34 years (ii) 35 - 49 years (iii) 50 - 64 years and > 65 years. A p-value of <0.05 was considered statistically significant. Results: A total of 31,930 candidates with HCV (i.e. primary diagnosis) were added to the LT waiting list. The study population consisted of 67% male with an ethnic distribution of White (64%), Hispanic (16%), Blacks (11%) and Asian (3%). During the study period (2002 - 2012), wait list addition for candidates with HCV decreased from 31% (2002) to 28% (2012). However, sub-analysis showed an ethnic variation in WLR. There was a decrease in WLR for White (30.2% to 26.5%), Hispanic (36.4% to 29.8%) and Asian (22% to 15.8%) but an increase for Blacks (35.2% to 40.3%) Figure 1. In addition, among the Blacks with HCV, there was a significant shift in age distribution between 2002 and 2012, reflecting the shifting baby boomer age group Figure 2. The proportion of HCV candidates in 2002 was 54% in the age group (35 - 49) and 40% (50 - 64) compared to 2012 was 6.1 % (35 - 49 yrs) and 85% (50 - 64 yrs). No gender variation was observed. Conclusion: Despite surveillance reports of declining HCV incidence in USA, the WLR for Blacks with HCV is steadily increasing. The disproportionate age distribution (50-64 yrs) in this population also supports the CDC recommendation for HCV testing of individuals in baby boomer age group. This study highlights the disproportionate burden of chronic HCV in Blacks and its implication in LT. In addition, the findings of this study identifies a target group (i.e. Blacks, “baby boomer age”) for focused interventions, with the goal of effectively eliminating the observed disparity in this ethnic minority group