US study reports dramatic reduction in likelihood of liver transplantation in patients with hepatoce

April 13, 2018, European Association for the Study of the Liver

Patients with hepatocellular carcinoma (HCC) waiting for a liver transplant in the USA are now significantly less likely to receive a new liver than they were around a decade ago. A nationwide study presented today at The International Liver Congress 2018 in Paris, France, has confirmed that patients with HCC on the liver transplant list in the USA were more than 50% less likely to receive a transplant in 2014-2016 than they were in 2005-2007. Patients with Medicaid insurance were also significantly less likely to undergo liver transplantation than those with private/commercial insurance. 'This is a very worrying trend and reflects the continued imbalance between the number of patients with HCC in need of liver transplantation and the limited number of donor livers available', said Dr. Jennifer Wang from the California Pacific Medical Center, San Francisco, USA, who presented the study findings today.

Hepatocellular carcinoma is the most common primary tumour of the liver, with average survival estimated to be 18 months. Liver transplantation is a guideline-recommended treatment for people with HCC, although individuals must meet strict criteria in order to join the waiting list. A recent study has shown that HCC is the most common indication for and placement on the waiting list in the USA.4 However, limited organ availability and an increasing demand has extended waiting times, and increased morbidity and mortality amongst those listed.

The study presented today was undertaken to evaluate overall trends in the probability of receiving a among US adults with HCC on the transplant list. Data from the United Network for Organ Sharing Liver Transplant Registry were analyzed by year of listing (2005-2007, 2008-2010, 2011-2013, and 2014-2016), and stratified by age and insurance type. When stratified by age, the probability of receiving a liver transplant within 1 year of listing was highest amongst HCC aged 50-59 years (64.6%) and lowest amongst those aged 60-69 years (58.1%) (p<0.01). When stratified by insurance type, the probability of receiving a liver transplant within 1 year was highest amongst those with private/commercial insurance (63.6%) and lowest amongst those with Medicare insurance (52.8%) (p<0.001). In 2005-2007, the probability of receiving a liver transplant in the first year of joining the waiting list was 81.5% compared with just 51.7% in 2014-2016 (p<0.001). A multivariate regression analysis confirmed that HCC patients who joined the liver transplant waiting list in 2014-2016 were significantly less likely to receive a transplant than those who joined the list in 2005-2007 (HR 0.43; 95% CI 0.40, 0.46; p<0.001).

'This means that, despite the increasing numbers of adults with HCC waiting for a liver transplant in the USA, patients are now 57% less likely to receive one than they were in the mid-2000s', said Dr. Wang.

As well as the lack of donor livers, Dr. Wang believes that the findings from her study also reflect disparities in the rates of liver transplantation amongst HCC patients—especially patients from ethnic minority backgrounds and those with Medicaid-type insurance. She also believes that the increasing burden of non-alcoholic fatty liver disease as a cause of HCC and the increasing numbers of patients with early-stage HCC that are eligible for liver transplantation have contributed to the current situation.

'Ultimately, this situation will only improve when newer therapies and more curative options for HCC become available', said Dr. Wang. 'In the meantime, we need more research to help us understand the disparities identified in our study so that targeted interventions can be developed to ensure more equitable access to liver transplantation for all our HCC patients'.

'This increase in the proportion of patients who are potential candidates for liver transplantation will be associated with an irremediable increase in the waiting time and of the drop-out due to tumour progression', said Prof. Alejandro Forner from the Hospital Clinic Barcelona, Spain, and EASL Governing Board Member. 'Efforts should be directed to design prioritising strategies to facilitate access to liver transplantation for patients affected by HCC, without harming the patients listed due to impaired function'.

Explore further: Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation

Related Stories

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation

April 11, 2018
Two independent studies have today reported that alcoholic liver disease has now replaced hepatitis C virus (HCV) infection as the leading cause of liver transplantation in the USA in patients without HCC. Non-alcoholic steatohepatitis ...

HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly

April 13, 2018
HCV-related liver transplantation rates in Europe have declined dramatically since the availability of direct-acting antiviral (DAA) drugs and survival rates after transplantation have reached an all-time high. A study presented ...

Alternatives to whole liver transplants for children have become safer, study finds

February 7, 2018
In a new Johns Hopkins study of patient and graft survival trends for pediatric liver transplant recipients between 2002 and 2015, researchers found that outcomes for alternatives to whole liver transplantation (WLT), such ...

Hep C infected livers offer similar outcomes to healthy livers in those waiting for liver transplant

April 14, 2016
Data from a new study presented today may help reduce the waiting time for a liver transplant for people with the Hepatitis C virus (HCV). The study, presented at The International Liver Congress 2016 in Barcelona, Spain, ...

Use of opioid pain medications may affect liver transplant patients' survival

March 2, 2017
An analysis of nearly 30,000 patients undergoing liver transplantation in the United States between 2008 and 2014 found elevated death and organ loss rates in the first 5 years after transplantation among recipients with ...

Medicaid expansion increased Medicaid enrollment among liver transplant recipients

July 26, 2016
Researchers have found that Medicaid expansion increased Medicaid enrollment among people who received liver transplants funded by commercial insurance. The findings are published inLiver Transplantation.

Recommended for you

Deadly Rift Valley fever: New insight, and hope for the future

July 19, 2018
Health control measures alone could be ineffective in the long term fight against the deadly Rift Valley fever which affects both humans and animals, a new study in the journal PNAS reports.

New guidelines to diagnose, manage rare endocrine disorders

July 19, 2018
International guidelines have been published for the first time to help doctors around the globe diagnose and manage patients with a very rare set of endocrine diseases known as pseudohypoparathyroidism and its related disorders, ...

Overuse of antibiotics not what the doctor ordered

July 19, 2018
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community ...

Alcohol-related cirrhosis deaths skyrocket in young adults

July 18, 2018
Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

Hidden blood in feces may signal deadly conditions

July 17, 2018
(HealthDay)—Even if it's not visible to the naked eye, blood in the stool can be serious—a sign of a potentially fatal disease other than colon cancer, new research suggests.

Childhood abuse linked to greater risk of endometriosis, study finds

July 17, 2018
Endometriosis, a painful condition that affects one in 10 reproductive-age women in the U.S., has been linked to childhood physical and sexual abuse, according to findings published today in the journal Human Reproduction.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.