Evaluating Racial Disparities in Liver Transplant Rates for Patients With HCC

Researchers of a recent study observed that after the 2015 model of end-stage liver disease (MELD) exception policy change, liver transplants (LTs) for patients with hepatocellular carcinoma (HCC) decreased for all racial groups, with Black or African American patients facing worse outcomes after LT.

The study was led by Dr. Behnam Saberi, of the Beth Israel Deaconess Medical Center, and published in JAMA.

In 2015, the Organ Procurement and Transplantation Network (OPTN) implemented a new policy requiring a 6-month delay prior to assigning a MELD score of 28. The requirement also mandated that the maximum HCC exception score could not exceed 34 points.

Prior research demonstrated that adding up to 6 months to the LT waiting list may have boosted equity for LT candidates with HCC. However, the effects of the updated 2015 MELD exception policy on race and survival after LT are still unknown.

Saberi and colleagues retrospectively evaluated OPTN data from adult patients with HCC both on the LT waiting list and who had received LT.

The study’s primary end point was survival following LT in eras 1 and 2. Its secondary end point was LT waiting list dropout. Researchers defined waiting list dropout as removal from the LT waiting list without receiving a transplant. Patients were either removed from the waiting list after deterioration of health or death.

Researchers found that following the 2015 changes to the MELD exception policy, the total number of LTs for patients with HCC decreased across all races.

Black or African American patients experienced the highest dropout rates in era 1 (24%) but demonstrated similar dropout rates (23%) with White (23%) and Hispanic (23%) populations in era 2.

Following LT, Asian patients reported the highest survival rates in era 1 (82%) and era 2 (86%), while Black or African American patients experienced the lowest survival rates in both eras (71% for era 1, 79% for era 2).

Researchers concluded that after the 2015 MELD exception policy change, LTs decreased for patients with HCC across all races. They also noted that Black or African American patients demonstrated worse outcomes following LT than other races. “Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates,” they wrote.