Racial disparities in the outcomes of liver transplantation in the treatment of hepatocellular carcinoma.

Abstract

4131 Background: According to the National Comprehensive Cancer Network (NCCN), liver transplantation (LT) is currently the treatment of choice for patients with early hepatocellular carcinoma (HCC). A retrospective study in 2016 showed a difference in mortality among races in patients undergoing treatment for HCC. Our study is the first to compare the outcomes of mortality, morbidity and hospital utilization of HCC patients undergoing LT among races in the US. Methods: This is a retrospective longitudinal study of patients with a primary diagnosis of HCC. We retrieved data from the Nationwide Inpatient Sample (NIS) databases from the years 2016 to 2020 using ICD-10 codes. Multivariate regression analysis was applied to compare the outcomes in races, adjusted for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics. We used STATA Version 17.0 Software for analysis. The p-value was set at p < 0.05 for statistical significance. Results: Among a total of 112,110 adults with HCC, 2.8% (n=3,150) underwent LT. Blacks had lower rates of LT. Blacks and Hispanics were found to have a lower income (p= 0.000). No difference in the Charlson Comorbidity index was noted among races (p=0.5519), however, Blacks had more smokers (p=0.0149). Hispanics had a significant increase in THC compared to Whites (coefficient: 102,058 US Dollars, p=0.033, CI95%: -109,404 - 119,787), with no difference in the length of stay among races. Blacks had higher rates of mortality (p=0.004), acute kidney injury (AKI) (p=0.001), and similar rates of transplant complications. Conclusions: Our study showed that while Blacks have lower rates of LT, they have a higher rate of mortality and morbidity following LT. Large scale studies are necessary to help determine factors associated with these findings.