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

Key takeaways:

• Hispanic and Asian patients were less likely to undergo LT for MASH-HCC than other races and ethnicities.
• Median MELD at transplant allocation has improved transplant rates among Hispanic patients.

BOSTON — Hispanic and Asian patients with metabolic dysfunction-associated steatohepatitis and hepatocellular carcinoma were less likely to undergo liver transplantation compared with other races and ethnicities, data showed.

“MASH-HCC rates are much higher in our Hispanic patients and have surpassed hepatitis C-related HCC in 2019,” David W. Victor, MD, associate professor of clinical medicine at Houston Methodist Hospital, said at The Liver Meeting. “Hispanics are disproportionately predisposed to MASH, and our Black patients often have reduced survival to HCC. Many members of our racial minorities have reduced access for treatment of HCC.”

Victor continued: “Previous studies have shown that minorities are less likely to be waitlisted. We wanted to determine whether those that are listed have adequate outcomes and to better understand barriers for transplantation.”

Victor and colleagues identified 3,810 adults with MASH-HCC waitlisted for LT between January 2015 and December 2021, most of whom were non-Hispanic white (n = 2,713), followed by Hispanic (n = 891), Asian (n = 115), other (n = 50) and Black (n = 41).

According to results, Hispanic patients were less likely to undergo LT compared with non-Hispanic white patients, while proportions of other patient groups receiving LT were similar. Waitlist mortality was not significantly different between groups.

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

“MELD score was a positive predictor of transplant and being transplanted after the median MELD at transplant exception change was a positive,” he added.

Of note, Hispanic patients received LT at significantly higher rates in the post-median MELD at transplant (MMAT) era vs. the pre-MMAT era; listings pre- and post-MMAT were similar between other groups.

“Race and ethnicity does affect your ability to undergo liver transplantation for the growing indication of MASH with HCC,” Victor concluded. “Hispanics underwent liver transplantation at a lower rate than our non-Hispanic whites. MMAT did have some positive effect on the transplantation rate for our Hispanic patients, but they still received transplant at a lower rate than our non-Hispanic whites.”

He continued, “This study shows that we need to improve access for liver transplantation and, even in those who are listed for MASH-HCC, there are significant differences for transplantation rates.”