The Impact of Etiology of Liver Disease and Indication for Transplantation on Access to the Liver Transplant Waiting List in the United States.
1Department of Medicine, University of Pennsylvania, Philadelphia, PA
2Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
Meeting: 2016 American Transplant Congress
Abstract number: B60
Keywords: Hepatocellular carcinoma, Waiting lists
Session Information
Session Name: Poster Session B: Disparities in Access and Outcomes
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Only a small fraction of patients with end-stage liver disease (ESLD) is waitlisted for liver transplantation (LT).
Methods: Retrospective cohort study of transplant-eligible ESLD patients in the HealthCore Integrated Research Database from 2006-2014 and 5-state Medicaid data (CA, FL, NY, OH, and PA) from 1999-2009. Transplant-eligible patients were defined based on established indications for waitlisting–decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC)–using validated ICD-9 algorithms, without malignancies precluding LT. Linkage with UNOS determined whether patients were waitlisted. Multivariable competing risk regression models estimated sub-hazard ratios (SHRs) for waitlisting, accounting for informative censoring due to death.
Results: 10.6% (1,779/16,824) and 8.2% (7,514/91,899) of transplant-eligible ESLD patients were waitlisted in HealthCore and Medicaid, respectively. Etiology of liver disease was significantly associated with waitlisting (Table 1). In HealthCore, 8.8% (1,324/14,971) of patients with DC were waitlisted vs. 24.6% (455/1,853) with HCC (p<0.001); 7.1% (5,835/82,699) of Medicaid patients with DC were waitlisted, vs. 18.3% (1,679/9,200) with HCC (p<0.001). Despite adjustments for etiology of liver disease, the increased probability of waitlisting for patients with HCC persisted in multivariable competing risk models
| Covariate | HealthCore | Medicaid |
| Etiology of liver disease | ||
| Hepatitis C | Reference | Reference |
| Alcohol-induced | 0.50 (0.44-0.58) | 0.42 (0.40-0.45) |
| Hepatitis B | 0.64 (0.45-0.90) | 0.84 (0.77-0.92) |
| NASH | 0.35 (0.26-0.45) | —————- |
| Primary sclerosing cholangitis | 1.69 (1.31-2.20) | 1.65 (1.47-1.86) |
| HCC as indication for waitlisting (ref: decompensated cirrhosis) | 2.72 (2.42-3.06) | 2.56 (2.41-2.71) |
. Among transplant-eligible ESLD patients in HealthCore, 4.0% (605/14,971) with DC were transplanted, compared to 15.0% (277/1,853) with HCC (p<0.001).
Conclusions: Access to the waitlist is strongly tied to etiology of liver disease and indication for waitlisting. Patients with HCC are preferentially waitlisted, which results in nearly four-times increased rates of transplantation in HCC patients compared to those with decompensated cirrhosis.
CITATION INFORMATION: Goldberg D, French B, Newcomb C, Liu Q, Lewis J, Halpern S. The Impact of Etiology of Liver Disease and Indication for Transplantation on Access to the Liver Transplant Waiting List in the United States. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Goldberg D, French B, Newcomb C, Liu Q, Lewis J, Halpern S. The Impact of Etiology of Liver Disease and Indication for Transplantation on Access to the Liver Transplant Waiting List in the United States. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-etiology-of-liver-disease-and-indication-for-transplantation-on-access-to-the-liver-transplant-waiting-list-in-the-united-states/. Accessed May 9, 2025.« Back to 2016 American Transplant Congress