Social and clinical determinants of liver transplant evaluation in hepatocellular carcinoma: A multicenter cohort study
8 affiliations
- 1Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California San Diego, San Diego, California, USA
- 2Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA
- 3Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- 4Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California, USA
- 5Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
- 6Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- 7Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- 8Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
Abstract
Background
Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) but requires timely referral. Comprehensive data on factors impacting LT referral and outcomes for HCC are limited. We evaluated social, system, and clinical factors associated with listing, LT, mortality, HCC stage at referral, and time from HCC diagnosis to referral.Methods
The California Liver Network is a consortium of 6 LT centers comprising >75% of adult LTs in California. Demographic, clinical, psychosocial, and social determinants of health and outcome data were collected for adults referred for LT. Multivariable regression identified factors associated with outcomes.Results
Of 9987 adults referred, 1573 (15.7%) had HCC. Median age was 63.3 years; 73% males, 40% Hispanic, and 26.1% Medicaid insurance. Median MELD was 12.7 (IQR 8-16), and median time from HCC diagnosis to LT referral was 124 days (IQR 32-410). In all, 10% were T1 and 70.5% were T2 at referral. Alpha-fetoprotein (AFP) (OR 0.99), HCC stage, Medicaid insurance (OR 0.55), LT site, and marital status (OR 1.90) were associated with listing. Transplantation was associated with HCC stage (OR 0.42) and LT site. Mortality was associated with MELD (OR 1.02), hypertension (OR 1.44), dialysis (OR 2.48), hepatic encephalopathy (OR 1.54), and portal vein thrombosis (OR 1.44). Referral at more advanced HCC stage was associated with male sex (OR 1.55), AFP (OR 1.01), Medicaid insurance (OR 1.40), primary language (OR 0.70), and prior HCC treatment type. Longer time to referral was associated with HCV/alcohol liver disease and prior HCC treatment type.Conclusions
In this multicenter study of adults with HCC, Medicaid insurance, LT site, HCC treatment history, and psychosocial factors were key determinants of HCC care cascade progression, identifying targets to improve LT access.
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BibTeX
@article{tincopa2026social,
title = {{Social and clinical determinants of liver transplant evaluation in hepatocellular carcinoma: A multicenter cohort study}},
author = {Monica Tincopa and Lana Bridi and Irine Vodkin and Mignote Yilma and Kali Zhou and Allison Kwong and Jasleen Singh and Neil Mehta and Alexander Kuo and Ryutaro Hirose and Steven A. Wisel and Justin A. Steggerda and Chris Freise and Veeral Ajmera},
journal = {Hepatology communications},
year = {2026},
month = oct,
doi = {10.1097/hc9.0000000000001068},
url = {https://europepmc.org/article/PMC/PMC13694066},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Social and clinical determinants of liver transplant evaluation in hepatocellular carcinoma: A multicenter cohort study
AU - Monica Tincopa
AU - Lana Bridi
AU - Irine Vodkin
AU - Mignote Yilma
AU - Kali Zhou
AU - Allison Kwong
AU - Jasleen Singh
AU - Neil Mehta
AU - Alexander Kuo
AU - Ryutaro Hirose
AU - Steven A. Wisel
AU - Justin A. Steggerda
AU - Chris Freise
AU - Veeral Ajmera
PY - 2026
DA - 2026/10/23
JO - Hepatology communications
DO - 10.1097/hc9.0000000000001068
UR - https://europepmc.org/article/PMC/PMC13694066
AB - Background Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) but requires timely referral. Comprehensive data on factors impacting LT referral and outcomes for HCC are limited. We evaluated social, system, and clinical factors associated with listing, LT, mortality, HCC stage at referral, and time from HCC diagnosis to referral.Methods The California Liver Network is a consortium of 6 LT centers comprising >75% of adult LTs in California. Demographic, clinical, psychosocial, and social determinants of health and outcome data were collected for adults referred for LT. Multivariable regression identified factors associated with outcomes.Results Of 9987 adults referred, 1573 (15.7%) had HCC. Median age was 63.3 years; 73% males, 40% Hispanic, and 26.1% Medicaid insurance. Median MELD was 12.7 (IQR 8-16), and median time from HCC diagnosis to LT referral was 124 days (IQR 32-410). In all, 10% were T1 and 70.5% were T2 at referral. Alpha-fetoprotein (AFP) (OR 0.99), HCC stage, Medicaid insurance (OR 0.55), LT site, and marital status (OR 1.90) were associated with listing. Transplantation was associated with HCC stage (OR 0.42) and LT site. Mortality was associated with MELD (OR 1.02), hypertension (OR 1.44), dialysis (OR 2.48), hepatic encephalopathy (OR 1.54), and portal vein thrombosis (OR 1.44). Referral at more advanced HCC stage was associated with male sex (OR 1.55), AFP (OR 1.01), Medicaid insurance (OR 1.40), primary language (OR 0.70), and prior HCC treatment type. Longer time to referral was associated with HCV/alcohol liver disease and prior HCC treatment type.Conclusions In this multicenter study of adults with HCC, Medicaid insurance, LT site, HCC treatment history, and psychosocial factors were key determinants of HCC care cascade progression, identifying targets to improve LT access.
SN - 2471-254X
ER -