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Lower rates of receiving model for end‐stage liver disease exception and longer time to transplant among nonalcoholic steatohepatitis hepatocellular carcinoma
Author(s) -
Young Kellie,
Aguilar Maria,
Gish Robert,
Younossi Zobair,
Saab Sammy,
Bhuket Taft,
Liu Benny,
Ahmed Aijaz,
Wong Robert J.
Publication year - 2016
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24507
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , gastroenterology , odds ratio , hepatitis c virus , alcoholic liver disease , liver disease , hepatitis c , cirrhosis , steatohepatitis , hepatitis b virus , model for end stage liver disease , fatty liver , transplantation , immunology , disease , virus
Receiving Model for End‐Stage Liver Disease (MELD) exception status for hepatocellular carcinoma (HCC) improves wait‐list survival and probability of liver transplantation (LT). We aim to evaluate etiology‐specific disparities in MELD exception, LT wait‐list times, and post‐LT outcomes among patients with HCC listed for LT. Using United Network for Organ Sharing 2004‐2013 data, we evaluated adults (age > 18 years) with HCC secondary to hepatitis C virus (HCV), nonalcoholic steatohepatitis (NASH), alcoholic cirrhosis (EtOH), hepatitis B virus (HBV), combined EtOH/HCV, and combined HBV/HCV. Multivariate regression models evaluated etiology‐specific odds of active exception, probability of receiving LT, and post‐LT survival. In total, 10,887 HCC patients were listed for LT from 2004 to 2013. Compared with HCV‐HCC patients (86.8%), patients with NASH‐HCC (67.7%), and EtOH‐HCC (64.4%) had a lower proportion with active MELD exception ( P < 0.001). On multivariate regression, NASH‐HCC and EtOH‐HCC patients had significantly lower odds of active MELD exception compared with HCV‐HCC (NASH‐HCC—odds ratio [OR], 0.73; 95% confidence interval [CI], 0.58‐0.93; P = 0.01; EtOH‐HCC—OR, 0.72; 95% CI, 0.59‐0.89; P = 0.002). Compared with HCV‐HCC patients, NASH‐HCC (HR, 0.83; 95% CI 0.76‐0.90; P < 0.001), EtOH‐HCC (HR, 0.88; 95% CI 0.81‐0.96; P = 0.002), and EtOH/HCV‐HCC (HR, 0.92; 95% CI 0.85‐0.99; P = 0.03) were less likely to receive LT if they had active exception. Without active exception, these discrepancies were more significant (NASH‐HCC—HR, 0.22; 95% CI, 0.18‐0.27; P < 0.001; EtOH‐HCC—HR, 0.22; 95% CI, 0.18‐0.26; P < 0.001; EtOH/HCV‐HCC—HR, 0.26; 95% CI, 0.22‐0.32; P < 0.001). In conclusion, among US adults with HCC listed for LT, patients with NASH‐HCC, EtOH‐HCC, and EtOH/HCV‐HCC were significantly less likely to have active MELD exception compared with HCV‐HCC, and those without active exception had a lower likelihood of receiving LT. More research is needed to explore why NASH‐HCC patients were less likely to have active MELD exception. Liver Transplantation 22 1356–1366 2016 AASLD .