title: Lower rates of receiving model for end-stage liver disease exception and longer time to transplant among nonalcoholic steatohepatitis hepatocellular carcinoma.
abstract: 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.
authors.affiliation: School of Medicine, University of California, San Francisco, CA.|Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA.
authors.forename: Kellie
authors.initials: K
authors.lastname: Young
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gish
authors.affiliation: Department of Medicine, Center for Liver Diseases, Falls Church, VA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
authors.forename: Zobair
authors.initials: Z
authors.lastname: Younossi
authors.affiliation: Departments of Medicine and Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA. rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D058625:End Stage Liver Disease / Q000175:diagnosis*; D005260:Female; D006509:Hepatitis B / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000601:surgery*; D011336:Probability; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014850:Waiting Lists