Takeaway
- Publicly insured liver transplant (LT) candidates with hepatocellular carcinoma (HCC) are more likely to drop off the waitlist than those with private insurance, despite similar tumor and disease-related characteristics.
Why this matters
- According to the authors, these findings appear to be associated with delays in completion of pre-LT evaluations and obtaining timely Model for End-Stage Liver Disease (MELD) exception upgrades.
Study design
- Study of 705 LT candidates (median age, 61 years; 76.2% male) with HCC carrying Kaiser Permanente insurance (49.5%), other private insurance (22.3%), or public insurance (28.2%).
- Median follow-up, 13.2 months.
- Funding: National Institute of Diabetes and Digestive and Kidney Diseases.
Key results
- 246 patients (34.9%) dropped off the waitlist, 174 (24.7%) had tumor progression/death.
- 2-year dropout rate for progression/death was highest with public insurance (P<.001), followed by other private and Kaiser Permanente insurance (35.5% vs 25.5% and 21.8%).
- 2-year deceased-donor LT rate was similar with Kaiser Permanente and other private insurance (67.3% vs 64.1%; P=.72) but lower with public insurance (48.5%; P<.001).
- In multivariate competing-risk analysis, dropout risk was similar with Kaiser Permanente and other private insurance (P=.10) but higher with public insurance (HR=1.69; P=.005).
- Other dropout risk factors included α-fetoprotein ≥100 ng/mL (HR=2.77; P<.001), baseline MELD score (HR/point=1.06; P<.001), and ≥3 baseline lesions (vs 1: HR=2.07; P=.004).
Limitations
- Monocentric, retrospective design.
References
References
