Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma

Frances J Bennett¹, Jessica M Keilson¹, Michael K Turgeon¹, Kailey M Oppat¹, Emilie A K Warren¹, Shimul A Shah², Vatche G Agopian³, Joseph F Magliocca¹, Andrew Cameron⁴, Susan L Orloff⁵, Chandrashekhar A Kubal⁶, Robert M Cannon⁷, Mohamed E Akoad⁸, Juliet Emamaullee⁹, Federico Aucejo¹⁰, Parsia A Vagefi¹¹, Mindie H Nguyen¹², Kiran Dhanireddy¹³, Marwan M Kazimi¹⁴, Christopher J Sonnenday¹⁵, David P Foley¹⁶, Marwan Abdouljoud¹⁷, Debra L Sudan¹⁸, Abhinav Humar¹⁹, M B Majella Doyle²⁰, William C Chapman²⁰, Shishir K Maithel²¹

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁴ Department of Surgery, Johns Hopkins, Baltimore, MD, USA.
⁵ Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
⁶ Department of Surgery, Indiana University Health, Indianapolis, IN, USA.
⁷ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Surgery, Lahey Hospital and Medical Center, Boston, MA, USA.
⁹ Department of Surgery, Keck Hospital of University of Southern California, Los Angeles, CA, USA.
¹⁰ Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.
¹¹ Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
¹² Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
¹³ Department of Surgery, Tampa General Hospital, Tampa, FL, USA.
¹⁴ Department of Surgery, Piedmont Healthcare, Atlanta, GA, USA.
¹⁵ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
¹⁶ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁷ Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
¹⁹ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
²⁰ Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA.
²¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.

PMID: 39414703
PMCID: PMC11931600 (available on 2026-01-01)
DOI: 10.1245/s10434-024-16317-2

Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma

Frances J Bennett et al. Ann Surg Oncol. 2025 Jan.

. 2025 Jan;32(1):426-437.

doi: 10.1245/s10434-024-16317-2. Epub 2024 Oct 16.

Authors

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁴ Department of Surgery, Johns Hopkins, Baltimore, MD, USA.
⁵ Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
⁶ Department of Surgery, Indiana University Health, Indianapolis, IN, USA.
⁷ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Surgery, Lahey Hospital and Medical Center, Boston, MA, USA.
⁹ Department of Surgery, Keck Hospital of University of Southern California, Los Angeles, CA, USA.
¹⁰ Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.
¹¹ Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
¹² Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
¹³ Department of Surgery, Tampa General Hospital, Tampa, FL, USA.
¹⁴ Department of Surgery, Piedmont Healthcare, Atlanta, GA, USA.
¹⁵ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
¹⁶ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁷ Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
¹⁹ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
²⁰ Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA.
²¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.

PMID: 39414703
PMCID: PMC11931600 (available on 2026-01-01)
DOI: 10.1245/s10434-024-16317-2

Abstract

Background: In the United States, hepatitis C virus-associated hepatocellular carcinoma incidence and mortality are highest among minorities. Socioeconomic constraints play a major role in inequitable treatment. We evaluated the association between race/ethnicity and outcomes in a population that overcame treatment barriers.

Methods: We report a retrospective cohort study of 666 patients across 20 institutions in the United States Hepatocellular Carcinoma Liver Transplantation Consortium from 2015 to 2019 with hepatitis C virus-associated hepatocellular carcinoma who completed direct-acting antiviral therapy and underwent liver transplantation. Patients were excluded if they had a prior liver transplantation, hepatocellular carcinoma recurrence, no prior liver-directed therapy, or if race/ethnicity data were unavailable. Patients were stratified by race/ethnicity. Primary outcomes were recurrence-free survival and overall survival, and secondary outcome was major postoperative complication.

Results: Race/ethnicity was not associated with differences in 5-year recurrence-free survival (White 90%, Black 88%, Hispanic 92%, Other 87%; p = 0.85), overall survival (White 85%, Black 84%, Hispanic 84%, Other 93%; p = 0.70), or major postoperative complication.

Conclusions: Race/ethnicity was not associated with worse oncologic or postoperative outcomes among those who completed direct-acting antiviral therapy and underwent liver transplantation, suggesting that overcoming socioeconomic constraints equalizes outcomes across racial/ethnic groups. Eliminating barriers that prohibit care access among minorities must be a priority.

Keywords: Clinical outcomes; Hepatitis-C virus associated hepatocellular carcinoma; Liver transplantation; Racial disparities; Racial/ethnic group minorities.

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Conflict of interest statement

Disclosures: M.B. Majella Doyle has served as an Intuitive proctor and OrganOx educator. Frances J. Bennett, Jessica M. Keilson, Michael K. Turgeon, Kailey M. Oppat, Emilie A.K. Warren, Shimul A. Shah, Vatche G. Agopian, Joseph F. Magliocca, Andrew Cameron, Susan L. Orloff, Chandrashekhar A. Kubal, Robert M. Cannon, Mohamed E. Akoad, Juliet Emamaullee, Federico Aucejo, Parsia A. Vagefi, Mindie H. Nguyen, Kiran Dhanireddy, Marwan M. Kazimi, Christopher J. Sonnenday, David P. Foley, Marwan Abdouljoud, Debra L. Sudan, Abhinav Humar, William C. Chapman, and Shishir K. Maithel have no relevant disclosures to declare.

References

1. Giles H, Garbutt T, Landrum J. Hepatocellular carcinoma. Crit Care Nurs Clin Am. 2022;34:289–301. 10.1016/j.cnc.2022.04.004. - DOI - PubMed
1. OPTN/SRTR 2020 Annual Data Report: Liver. US Department of Health & Human Services Health Resources and Services Administration. https://srtr.transplant.hrsa.gov/annual_reports/2020/Liver.aspx. Accessed 12 Jan 2024.
1. Abdelhamed W, El-Kassas M. Hepatocellular carcinoma and hepatitis C virus treatments: the bold and the beautiful. J Viral Hepat. 2023;30(2):148–59. 10.1111/jvh.13778. - DOI - PubMed
1. Kim H, El-Serag HB. The epidemiology of hepatocellular carcinoma in the USA. Curr Gastroenterol Rep. 2019;21:17. 10.1007/s11894-019-0681-x. - DOI - PubMed
1. Turgeon MK, Shah SA, Delman AM, et al. Optimal timing of administration of direct-acting antivirals for patients with hepatitis C-associated hepatocellular carcinoma undergoing liver transplantation. Ann Surg. 2021;274(4):613–20. 10.1097/SLA.0000000000005070. - DOI - PMC - PubMed

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Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma

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Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma

Authors

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Abstract

Conflict of interest statement

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