Racial Disparities in Post-transplant Outcomes for Hepatocellular Carcinoma: Systematic Review and Meta-analysis

Liver transplant remains the favored modality for the treatment of hepatocellular carcinoma. However, disparities in post-transplant outcomes across ethnic groups persist. Our review aimed to clarify the association between ethnicity and the studied outcomes.

A systematic literature search in accordance with the PRISMA protocol extracted articles from inception upto April 21, 2025. Outcomes of interest included overall patient and graft survival after liver transplant. The Newcastle-Ottawa Scale assessed the risk of bias. Meta-analysis was performed using the random effects model in RevMan Web. The GRADE tool assessed certainty of evidence.

The review included twelve retrospective cohort studies covering diverse ethnic populations, including White, Black, Asian, and Hispanic groups. Across the studies reviewed, Black patients generally showed the poorest overall patient and graft survival, whereas Asian patients tended to have the best patient survival, irrespective of follow-up duration. Meta-analyses found that Black patients (HR = 1.27; 95% CI = 1.12, 1.44; P = 0.002; I² = 55%) had worse posttransplant survival rates, while Asian patients (HR = 0.90; 95% CI = 0.79, 1.02; P = 0.11; I² = 0%) and Hispanic patients (HR = 0.86; 95% CI = 0.71, 1.05; P = 0.15; I² = 59%) had similar survival chances compared to White patients, with moderate confidence in the meta-analysis effect estimates.

Black patients with hepatocellular carcinoma had consistently worse post-transplant outcomes compared to other ethnicities. Future research should involve larger, multi-ethnic cohorts, adjust for key confounding variables, and explore factors underlying worse post-transplant outcomes in certain racial groups.