Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia

Katherine Ross-Driscoll ^1,2,3, Arrey-Takor Ayuk-Arrey ², Raymond Lynch ⁴

⁰Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

Cancer Research Communications +

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March 22, 2024

View abstract on PubMed

Summary

Access to liver transplantation for early-stage hepatocellular carcinoma (HCC) is unequal. Sociodemographic factors like insurance and poverty create barriers at each step of the transplant process, impacting referral, evaluation, and completion.

Area Of Science

Hepatobiliary Surgery
Transplant Surgery
Surgical Oncology

Background

Liver transplantation is the optimal treatment for early-stage hepatocellular carcinoma (HCC).
Previous research identified disparities in transplant access, but early referral and evaluation stages remain understudied.
Understanding these initial steps is crucial for improving equitable access to liver transplantation.

Purpose Of The Study

To identify sociodemographic determinants of access to liver transplant referral and evaluation among patients with early-stage HCC in Georgia.
To examine barriers at each stage: referral, evaluation initiation, and evaluation completion.

Main Methods

Population-based cancer registry data (2010-2019) from Georgia were linked to liver transplant centers.
A cohort of adult patients with early-stage HCC (single tumor ≤8 cm, no extrahepatic/vascular involvement) was analyzed.
Time-to-event analyses (referral, evaluation initiation/completion) were performed, accounting for the competing risk of death and non-transplant cancer treatment.

Main Results

Only 26% of eligible early-stage HCC patients were referred for liver transplant.
Private insurance and younger age increased referral likelihood; downstaging criteria decreased it.
Poverty was linked to lower evaluation initiation rates, and Medicaid to lower evaluation completion rates.

Conclusions

Sociodemographic factors significantly influence each stage of the liver transplant process for HCC patients.
Targeted interventions are needed to address unique barriers in referral, evaluation initiation, and completion.
Improving transplant access requires addressing insurance requirements, socioeconomic barriers, and streamlining the evaluation process.