肝细胞癌 (HCC) 肝移植 (LT) 的种族差异可能与获得挽救生命的治疗机会不平等有关。为了量化 HCC 肝移植 (LT) 和 LT 后死亡率的种族差异，调整人口、临床和社会经济因素。队列研究是对 2003 年至 2021 年联合网络器官共享/器官采购移植网络 (OPTN) 数据的回顾性分析。参与者是 LT 等待名单上的成年 HCC 患者和接受 LT 的患者。分析了 2022 年 3 月至 2023 年 9 月的数据。2015 年 OPTN 政策变更前后的种族和时间。候补名单中的 LT 比例、候补名单删除比例以及 LT 后的死亡率。在 12031 名候补患者中LT 合并 HCC（平均 [SD] 年龄，60.8 [7.4] 岁；9054 [75.3%] 男性；7234 [60.1%] 白人，2590 [21.5%] 拉丁裔/o/a，1172 [9.7%] 黑人或非裔美国人），这项研究发现，2015 年终末期肝病 (MELD) 模型 HCC 例外政策变更（第 2 代）后，所有种族的 HCC LT 总体比例下降，而 LT 退出比例与未患有 HCC 的患者相比，等候名单保持稳定。在 Kaplan-Meier 分析中，亚洲患者在第 1 代和第 2 代表现出最低的辍学率（1 年辍学率分别为 16% 和 17%；P < .001）。相比之下，黑人或非裔美国患者在第 1 阶段的退出率最高（1 年退出率，24%），但在第 1 阶段与白人患者 (23%) 和拉丁裔/o/a 患者的退出率 (23%) 相当。 2（23%）。在这两个时代，亚洲患者 LT 后的生存率最高（5 年生存率，第 1 时代为 82%，第 2 时代为 86%），而黑人或非裔美国患者 LT 后生存率最差（5 年生存率，71时代 1 为 %，时代 2 为 79%）。在 HCC LT 接受者的多变量分析中，与白人种族相比，黑人或非裔美国人种族在两个时代都与死亡风险增加相关（第 1 时代的 HR，1.17；95% CI，1.05-1.35；第 2 时代的 HR） , 1.31; 95% CI, 1.10-1.56)。 这项针对美国 LT 候选人的队列研究发现，2015 年 MELD 针对 HCC 的例外政策变更后，所有种族的 HCC LT 比例均有所下降。黑人或非裔美国患者在 LT 后的结果比其他种族的患者更差。需要进一步研究来确定这种差异的根本原因，并制定策略来改善 HCC LT 候选者的结果。

Racial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment.To quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors.This cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021. Participants were adult patients with HCC on the LT waiting list and those who received LT. Data were analyzed from March 2022 to September 2023.Race and time before and after the 2015 OPTN policy change.Proportion of LT from wait-listed candidates, the proportion of waiting list removals, and mortality after LT.Among 12 031 patients wait-listed for LT with HCC (mean [SD] age, 60.8 [7.4] years; 9054 [75.3%] male; 7234 [60.1%] White, 2590 [21.5%] Latinx/o/a, and 1172 [9.7%] Black or African American), this study found that after the 2015 model of end-stage liver disease (MELD) exception policy changes for HCC (era 2), the overall proportion of LT for HCC across all races decreased while the proportion of dropouts on the LT waiting list remained steady compared with patients who did not have HCC. In Kaplan-Meier analysis, Asian patients demonstrated the lowest dropout rates in both era 1 and era 2 (1-year dropout, 16% and 17%, respectively; P < .001). In contrast, Black or African American patients had the highest dropout rates in era 1 (1-year dropout, 24%), but comparable dropout rates (23%) with White patients (23%) and Latinx/o/a patients in era 2 (23%). In both eras, Asian patients had the highest survival after LT (5-year survival, 82% for era 1 and 86% for era 2), while Black or African American patients had the worst survival after LT (5-year survival, 71% for era 1 and 79% for era 2). In the multivariable analysis for HCC LT recipients, Black or African American race was associated with increased risk of mortality in both eras, compared with White race (HR for era 1, 1.17; 95% CI, 1.05-1.35; and HR for era 2, 1.31; 95% CI, 1.10-1.56).This cohort study of LT candidates in the US found that after the 2015 MELD exception policy change for HCC, the proportion of LT for HCC had decreased for all races. Black or African American patients had worse outcomes after LT than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates.