In the Journals

Patients with NASH-HCC less likely to receive liver transplant

Patients with nonalcoholic steatohepatitis and hepatocellular carcinoma are less likely to receive a liver transplant compared with patients with hepatitis C virus and hepatocellular carcinoma, according to recent findings published in Liver Transplantation.

“Among adults with HCC listed for [liver transplant] in the U.S., our study shows that NASH-HCC patients are significantly less likely to have active exception at time of [liver transplant] compared to HCV-HCC patients, and consequently have a lower likelihood of receiving [liver transplant],” Kellie Young, MD, resident physician of internal medicine at Santa Clara Valley Medical Center, and colleagues wrote. “While there were no significant post-[liver transplant] survival differences between NASH-HCC and HCV-HCC patients, because exception status does affect time on the waitlist and probability of receiving [liver transplant], NASH-HCC patients might be at higher risk of death due to de-listing from the [liver transplant] waitlist secondary to disease progression or death.”

In 2002, the MELD allocation system for liver transplantation was created to predict mortality and prioritize patients on the waitlist for liver transplant. Several studies have described an inequality in the waitlist model among patients with HCC compared with patients without HCC; however, it is unknown whether this difference exists for patients with different etiologies of HCC.

Young and colleagues evaluated etiology-specific differences in the MELD score, liver transplant wait times and post-liver transplant outcomes among patients with HCC. Using data from the United Network for Organ Sharing between 2004 and 2013, the researchers evaluated 10,887 adults with HCC combined with HCV, NASH, alcoholic cirrhosis, HBV, ethyl alcohol/HCV and HBV/HCV. Afterward, the researchers used multivariate regression to determine any association between etiology and active exception, probability of receiving a liver transplant and post-liver transplant survival.

Compared with HCV-HCC (86.8%), patients with NASH-HCC (67.7%) and EtOH-HCC (64.4%) had a lower proportion with an active MELD exception (P < .001). In the multivariate regression, NASH-HCC (OR = 0.73; 95% CI, 0.58-0.93) and EtOH-HCC (OR = 0.72; 95% CI, 0.59-0.89) patients were less likely to receive an active exception compared with HCV-HCC. In addition, NASH-HCC (HR = 0.83; 95% CI) and EtOH-HCC (HR = 0.88; 95% CI, 0.81-0.96) were less likely to receive a liver transplant if they had an active exception. Without the active exception, the discrepancies were even more significant for NASH-HCC (HR = 0.22; 95% CI, 0.18-0.27), for EtOH-HCC (HR = 0.22; 95% CI, 0.18-0.26) and for EtOH/HCV-HCC (HR = 0.26; 95% CI, 0.22-0.32).

“Future studies are needed to explore how disease etiologies and exception status affect waitlist mortality,” the researchers wrote. – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.

Patients with nonalcoholic steatohepatitis and hepatocellular carcinoma are less likely to receive a liver transplant compared with patients with hepatitis C virus and hepatocellular carcinoma, according to recent findings published in Liver Transplantation.

“Among adults with HCC listed for [liver transplant] in the U.S., our study shows that NASH-HCC patients are significantly less likely to have active exception at time of [liver transplant] compared to HCV-HCC patients, and consequently have a lower likelihood of receiving [liver transplant],” Kellie Young, MD, resident physician of internal medicine at Santa Clara Valley Medical Center, and colleagues wrote. “While there were no significant post-[liver transplant] survival differences between NASH-HCC and HCV-HCC patients, because exception status does affect time on the waitlist and probability of receiving [liver transplant], NASH-HCC patients might be at higher risk of death due to de-listing from the [liver transplant] waitlist secondary to disease progression or death.”

In 2002, the MELD allocation system for liver transplantation was created to predict mortality and prioritize patients on the waitlist for liver transplant. Several studies have described an inequality in the waitlist model among patients with HCC compared with patients without HCC; however, it is unknown whether this difference exists for patients with different etiologies of HCC.

Young and colleagues evaluated etiology-specific differences in the MELD score, liver transplant wait times and post-liver transplant outcomes among patients with HCC. Using data from the United Network for Organ Sharing between 2004 and 2013, the researchers evaluated 10,887 adults with HCC combined with HCV, NASH, alcoholic cirrhosis, HBV, ethyl alcohol/HCV and HBV/HCV. Afterward, the researchers used multivariate regression to determine any association between etiology and active exception, probability of receiving a liver transplant and post-liver transplant survival.

Compared with HCV-HCC (86.8%), patients with NASH-HCC (67.7%) and EtOH-HCC (64.4%) had a lower proportion with an active MELD exception (P < .001). In the multivariate regression, NASH-HCC (OR = 0.73; 95% CI, 0.58-0.93) and EtOH-HCC (OR = 0.72; 95% CI, 0.59-0.89) patients were less likely to receive an active exception compared with HCV-HCC. In addition, NASH-HCC (HR = 0.83; 95% CI) and EtOH-HCC (HR = 0.88; 95% CI, 0.81-0.96) were less likely to receive a liver transplant if they had an active exception. Without the active exception, the discrepancies were even more significant for NASH-HCC (HR = 0.22; 95% CI, 0.18-0.27), for EtOH-HCC (HR = 0.22; 95% CI, 0.18-0.26) and for EtOH/HCV-HCC (HR = 0.26; 95% CI, 0.22-0.32).

“Future studies are needed to explore how disease etiologies and exception status affect waitlist mortality,” the researchers wrote. – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.