Liver cancer: publicly insured more likely to drop off transplant waitlist

  • Gutin L & al.
  • JAMA Netw Open
  • 2 Aug 2019

  • International Clinical Digest
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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 vs>
  • 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 and lesions hr="2.07; P=.004).</li">

Limitations

  • Monocentric, retrospective design.