‘Significant differences’ in MASH-HCC transplant rates by race, ethnicity

Key points:

• Hispanic and Asian patients are less likely to undergo LT for MASH-HCC than other racial and ethnic groups.
• Median MELD at transplant allocation improves transplantation rates among Hispanic patients.

BOSTON — Hispanic and Asian patients with metabolic dysfunction-related steatohepatitis and hepatocellular carcinoma are less likely to receive a liver transplant than other racial and ethnic groups, data show.

“The incidence of MASH-HCC in our Hispanic patients is much higher and exceeded that of hepatitis C-related HCC in 2019,” David W. Victor, MD, associate professor of clinical medicine at Houston Methodist Hospital said at the Liver Conference. “Hispanics are more likely to develop MASH, and our black patients tend to have reduced survival rates with HCC. “Many of our minority members have reduced access to HCC treatment. “

“Previous research has shown that minorities are less likely to be waitlisted,” Victor continued. “We wanted to determine whether those listed had adequate outcomes and better understand the barriers to transplantation.” “

Victor and colleagues identified 3,810 adults with MASH-HCC awaiting LT between January 2015 and December 2021, the majority of whom were non-Hispanic whites (n = 2,713), followed by Hispanics (n = 891), Asian (n = 115), other (n = 50), and black (n = 41).

Results showed that Hispanic patients were less likely to receive LT than non-Hispanic white patients, whereas other patient groups received LT at similar rates. Waitlist mortality did not differ significantly between groups.

Victor also noted that men were more likely to receive a transplant (HR = 1.16; 95% CI, 1.04-1.29), while Hispanics (HR = 0.85; 95% CI, 0.77-0.95) and Asians (HR = 0.79; 95% CI, 1.04-1.29) were more likely to receive a transplant. , 0.63-0.98) patients were less likely to undergo LT.

“MELD score is a positive predictor of transplantation, and transplantation occurs after a positive median MELD for abnormal changes in transplantation,” he added.

Of note, Hispanic patients received LT at significantly higher rates in the median MELD post-transplant (MMAT) era than in other eras. Pre-MMAT era; pre- and post-MMAT lists are similar in other groups.

“Race and ethnicity do impact your ability to receive a liver transplant to address the growing number of MASH complications with HCC,” Victor concluded. “Hispanics receive liver transplants at a lower rate than non-Hispanic whites. MMAT does have some positive effects on transplant rates for our Hispanic patients, but they still receive transplants at a lower rate than our non-Hispanic whites.”

He continued, “This study demonstrates that we need to improve access to liver transplantation, as there are significant differences in transplantation rates even among those patients classified as MASH-HCC.”