Society for Surgery of the Alimentary Tract
SSAT Home SSAT Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


LIVER TRANSPLANTATION FOR EARLY HEPATOCELLULAR CARCINOMA AT MINORITY- VS. NON-MINORITY-SERVING HOSPITALS
Mohamedraed Elshami*1, Lauryn K. Bailey2, Richard S. Hoehn1, John Ammori1, Jeffrey Hardacre1, J. Eva Selfridge1, David Bajor1, Amr Mohamed1, Sakti Chakrabarti1, Amit Mahipal1, Jordan M. Winter1, Lee M. Ocuin1
1Department of Surgery, UH Cleveland Medical Center, Cleveland, OH; 2Case Western Reserve University, Cleveland, OH


Background

We examined the disparities in undergoing liver transplantation at minority-serving hospitals (MSH) versus non-MSH among patients with early-stage hepatocellular carcinoma (HCC). In addition, we investigated associations between liver transplantation and overall survival (OS), stratified by MSH status.

Methods

Patients with early HCC, defined as cT1, were identified within the National Cancer Database (2004-2018). The primary outcome was undergoing liver transplantation. The MSH status for each hospital was determined based on the proportion of minority (non-Hispanic Black or Hispanic) patients, where hospitals were ranked based on the proportion of minority patients and those in the top decile were considered MSH.

Results

A total of 46,703 patients with early HCC were identified, of whom 4214 (9.0%) were treated at MSH. Patients treated at MSH were more likely than those treated at non-MSH to be younger, live in a metropolitan area, and travel a shorter distance to treating facility. However, patients treated at MSH were less likely to live in areas with higher education and median income, have private insurance, and receive care at high-volume hospitals.
Throughout the study period, there was a declining trend for undergoing liver transplantation to patients with early HCC at both MSH and non-MSH. However, patients treated at MSH were less likely to undergo liver transplantation than patients treated at non-MSH (11.6% vs. 19.3%, OR=0.70, 95% CI: 0.59-0.83). Minority patients who were treated at non-MSH were less likely to undergo liver transplantation than White patients (OR=0.82, 95% CI: 0.75-0.90). However, minority patients had a further associated decrease in the likelihood of undergoing liver transplantation when treated at MSH (OR=0.65, 95% CI: 0.46-0.93) as compared to White patients.
Patients who underwent liver transplantation had an associated improvement in OS compared to those who did not when treated either at non-MSH (median OS: 147.4 vs. 24.6; HR=0.30, 95% CI: 0.28-0.33; Figure) or MSH (median OS: not reached vs. 26.5 months; HR=0.25, 95% CI: 0.19-0.34). Regardless of MSH status, there were no clinically meaningful differences in OS between White and minority patients who underwent liver transplantation.

Conclusions

Patients with early HCC had an associated decrease in the likelihood of undergoing liver transplantation when treated at MSH. Compared to White patients, minority patients treated at non-MSH had an associated decrease in the likelihood of undergoing liver transplantation, but to a lesser extent when treated at non-MSH. Liver transplantation was associated with improved survival outcomes regardless of race or MSH status.



Back to 2023 Abstracts