Association of Clinical, Psychosocial, and Social Determinants of Health Factors and Liver Transplantation and Waitlist Removal for MASH.

Background: Patients with metabolic dysfunction-associated steatohepatitis (MASH) have distinct medical comorbidities, psychosocial and social determinants of health (SDOH) factors that may impact liver transplantation (LT) rates. The aim of this study was to identify clinical, psychosocial and SDOH factors associated with rates of LT and LT waitlist removal based on MASH etiology.

Methods: This was retrospective cohort study at a large academic transplant center. Adults listed for LT between January 2018 and December 2020 were included. Patients listed as status 1A and those with prior LT were excluded. Demographic, clinical, psychosocial and SDOH characteristics were evaluated. Factors associated with LT and LT waitlist removal were analyzed using univariate and multivariate logistic regression.

Results: A total of 374 patients were included, of which 19% (n = 70) had MASH. MASH candidates more likely to be older (62 versus 57), female (63% versus 35%), and of Latino/Hispanic ethnicity (76% versus 43%). Patients with MASH had significantly lower Stanford Integrated Psychosocial Assessment for Transplant scores, substance use, years of formal education, and private insurance, and had higher percentages of long-term partners. The rate of LT and waitlist removal (including death) did not significantly differ by MASH status. Patients with MASH were significantly more likely to die on the waitlist (62% versus 27%). On multivariate analysis, male sex (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.01-2.92; P = 0.03) and lower Karnofsky score (OR, 0.98; 95% CI, 0.97-0.99; P < 0.01) were independently associated with LT, whereas unemployment (OR, 0.44; 95% CI, 0.23-0.84; P = 0.01) was associated with waitlist removal.

Conclusions: Rates of LT and LT waitlist removal did not significantly differ by MASH etiology, though patients with MASH were significantly more likely to die on the LT waitlist. There continue to be SDOH factors associated with rates of LT, with male sex and employment independently conferring higher odds of access to LT.