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WASHINGTON -- African-American patients at a major liver transplant center in the Midwest received liver transplantation less often than their white counterparts, even though they had about the same degree of illness, researchers said here.
In a 15-year cohort of liver cancer patients treated at two Indiana University clinics, 14% of African-American liver cancer patients underwent transplants compared with 26% of Caucasian patients (P=0.001), despite both groups having similar MELD (Model for End-Stage Liver Disease) scores, Child-Pugh scores, and BCLC (Barcelona Clinic Liver Cancer) staging, Lauren Nephew, MD, a transplant pathologist at Indiana University in Indianapolis, and colleagues said in a poster presentation at the .
"[The reason] is not clear exactly why that is," said Nephew. "You would think [it was because black patients were sicker], but our data doesn't suggest that ... and we didn't see a lot of difference in terms of their tumor stage."
Nephew said she has started delving into patients' charts, looking at patients who met transplant criteria but weren't transplanted, to see why that did not occur. "Are people scared? Are they uninformed, not interested? Are they offered transplants? Is it a provider [issue] where they are not being referred, or are they being referred and then declining, or are there barriers along the way," such as insurance issues? "We have the ability to really dive in and see what happened."
Disparities have been noted previously among ethnic groups in liver disease prevalence, treatment, and mortality, the researchers noted in their poster. To explore the issue further, they used the Indiana cancer registry to analyze data on all liver cancer patients treated at two large Indiana University health centers from January 2000 to June 2014. The group of 1,250 patients included 1,032 Caucasians, 164 African Americans, 24 Asians, and 22 Hispanics; six patients were listed as "other" and two as "unknown."
The Caucasian patients were slightly older than the African-American patients (mean age 62 years for Caucasians versus 60 years for African Americans). There was a higher percentage of females in the African American group (30% versus 26%) and a higher prevalence of hypertension (64% versus 54%).
African Americans also had a higher incidence of cirrhosis (92% versus 88%), and their mean tumor size was higher (5.30 cm versus 4.86 cm). There was also a higher prevalence of alcohol abuse in the African American group (59% versus 42%, P<0.001).
On the other hand, mean body mass index was slightly lower in the African American group (27 versus 29) and there was a lower incidence of diabetes (37% versus 38%).
Mean MELD scores were similar in both groups, at 13.59 for African Americans and 12.45 for whites. In terms of BCLC scores, slightly more African-American patients were scored as Stage A (27% versus 25%) and fewer were at Stage B (8% versus 13%). Disease etiology was also different in each group, with 83.4% of African Americans being diagnosed with viral hepatitis, compared with 51.5% of Caucasians.
In terms of treatment, more African-American patients received palliative or hospice care (31% versus 20%, P=0.001), and fewer underwent resection of their tumors, for which there was a trend toward significance (10% versus 16%, P=0.063). Overall survival was similar at 27% for African Americans and 29% for Caucasians.
The findings of this study are surprising, said Therese Bittermann, MD, a transplant hepatology fellow at the University of Pennsylvania in Philadelphia. "This question of why the transplant rates are so much lower is a really interesting finding ... it is a pretty significant difference between the two."
This finding could lead to further research on other ethnic groups, she added. "It's worth exploring other ethnicities as well; some parts of country have more Hispanic populations, and maybe they have a similar breakdown -- or they don't. It's an issue of finding things you can act on to improve care" for any group within the transplant community, she added.
Disclosures
Nephew had no disclosures.