Author information

¹Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.

²Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

³Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

⁴Department of Surgery, Johns Hopkins, Baltimore, MD, USA.

⁵Department of Surgery, Oregon Health and Science University, Portland, OR, USA.

⁶Department of Surgery, Indiana University Health, Indianapolis, IN, USA.

⁷Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

⁸Department of Surgery, Lahey Hospital and Medical Center, Boston, MA, USA.

⁹Department of Surgery, Keck Hospital of University of Southern California, Los Angeles, CA, USA.

¹⁰Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.

¹¹Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

¹²Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.

¹³Department of Surgery, Tampa General Hospital, Tampa, FL, USA.

¹⁴Department of Surgery, Piedmont Healthcare, Atlanta, GA, USA.

¹⁵Department of Surgery, University of Michigan, Ann Arbor, MI, USA.

¹⁶Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

¹⁷Department of Surgery, Henry Ford Health System, Detroit, MI, USA.

¹⁸Department of Surgery, Duke University School of Medicine, Durham, NC, USA.

¹⁹Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

²⁰Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA.

²¹Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.

Abstract

Background: In the United States, hepatitis C virus-associated hepatocellular carcinoma incidence and mortality are highest among minorities. Socioeconomic constraints play a major role in inequitable treatment. We evaluated the association between race/ethnicity and outcomes in a population that overcame treatment barriers.

Methods: We report a retrospective cohort study of 666 patients across 20 institutions in the United States Hepatocellular Carcinoma Liver Transplantation Consortium from 2015 to 2019 with hepatitis C virus-associated hepatocellular carcinoma who completed direct-acting antiviral therapy and underwent liver transplantation. Patients were excluded if they had a prior liver transplantation, hepatocellular carcinoma recurrence, no prior liver-directed therapy, or if race/ethnicity data were unavailable. Patients were stratified by race/ethnicity. Primary outcomes were recurrence-free survival and overall survival, and secondary outcome was major postoperative complication.

Results: Race/ethnicity was not associated with differences in 5-year recurrence-free survival (White 90%, Black 88%, Hispanic 92%, Other 87%; p = 0.85), overall survival (White 85%, Black 84%, Hispanic 84%, Other 93%; p = 0.70), or major postoperative complication.

Conclusions: Race/ethnicity was not associated with worse oncologic or postoperative outcomes among those who completed direct-acting antiviral therapy and underwent liver transplantation, suggesting that overcoming socioeconomic constraints equalizes outcomes across racial/ethnic groups. Eliminating barriers that prohibit care access among minorities must be a priority.