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Tissue Transplantation01:24

Tissue Transplantation

358
Tissue transplantation is a significant medical procedure involving the transfer of cells, tissues, or organs from a donor to a recipient, with the primary aim of restoring lost functions. This procedure is crucial in treating a broad spectrum of diseases, including kidney diseases, liver failure, heart disease, and certain types of cancers.
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
358
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  11. Racial-ethnic Differences In Liver Transplant Waitlist Outcomes In Patients With Hepatocellular Carcinoma Before And After Recent Changes To Allocation Policy

Racial-ethnic differences in liver transplant waitlist outcomes in patients with hepatocellular carcinoma before and after recent changes to allocation policy

Rafal D Mazur1, David C Cron2, David S Goldberg3

  • 1Harvard Medical School, Boston, Massachusetts, USA.

Clinical Transplantation
|May 28, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

The 2019 MELD exception policy change for liver transplant (LT) candidates with hepatocellular carcinoma (HCC) reduced LT incidence for White, Black, and Asian patients but mitigated disparities for Hispanic patients. The policy decreased inequities in waitlist outcomes by race and ethnicity.

Area of Science:

  • Transplant Surgery
  • Hepatology
  • Health Services Research

Background:

  • Liver transplant (LT) allocation policy for hepatocellular carcinoma (HCC) changed in May 2019, limiting MELD exception points to median MELD at transplant minus three (MMaT-3).
  • This policy aimed to impact waitlist outcomes for HCC candidates, with a focus on potential reductions in racial and ethnic inequities.

Purpose of the Study:

  • To evaluate the impact of the MMaT-3 policy on liver transplant waitlist outcomes stratified by race and ethnicity.
  • To determine if the policy change reduced existing disparities in waitlist outcomes among HCC patients.

Main Methods:

  • Retrospective cohort study using the Scientific Registry for Transplant Recipients (N=10,751 adult LT candidates with HCC exception points).
  • Comparison of pre-policy (May 2017-May 2019) and post-policy (May 2019-March 2021) waitlist outcomes, including LT incidence and removal for death or becoming too sick.
Keywords:
ethnicityhepatocellular carcinomaliver transplantationrace

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  • Competing risk regression analysis adjusted for candidate characteristics, comparing non-Hispanic White, non-Hispanic Black, Hispanic/Latinx, and Asian patients.

    • Main Results:

    • One-year LT incidence decreased significantly post-policy for White and Black candidates, but not Hispanic candidates.
    • Hispanic patients showed a significant decrease in death or waitlist removal post-policy.
    • Adjusted analysis revealed decreased LT incidence for White, Black, and Asian patients, with no change for Hispanic patients. Hispanic patients experienced a higher likelihood of LT post-policy compared to Whites, mitigating prior disparities.
    • Asian patients had a significantly lower incidence of death/non-LT waitlist removal post-policy compared to White patients.

    Conclusions:

    • The MMaT-3 policy differentially affected racial and ethnic subpopulations of liver transplant candidates with HCC.
    • The policy resulted in a post-implementation reduction of some, but not all, previous racial and ethnic disparities in waitlist outcomes.
    waitlist outcomes