Evidence map›Paper›PMID 40764459›Full record

ArticleDigestive diseases and sciences2026

Social Determinants Are Important Barriers to Completion of the Liver Transplant Pathway and Are Associated with Waitlisting and Mortality in Hepatocellular Carcinoma.

Brittany Baker, Tarek G Aridi, Meera Patel, Allie Carter, Carolyn Singleton, Katie Ross-Driscoll, Eric Orman, Archita P Desai, Marwan Ghabril, Naga Chalasani and 3 more

Abstract read
In one paragraph

Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. The UK National Appeals Panel Safely Extends Access to Liver Transplantation for Candidates Beyond Standard Listing Criteria.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Brittany BakerInternal Medicine Residency, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Tarek G AridiInternal Medicine Residency, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Meera PatelInternal Medicine Residency, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Allie CarterDepartment of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Carolyn SingletonInternal Medicine Residency, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Katie Ross-DriscollDepartment of Surgery, The Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Eric OrmanDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA.
Archita P DesaiDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA.
Marwan GhabrilDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA.
Naga ChalasaniDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA.
Shekhar KubalDepartment of Surgery, The Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
John HoldenDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA.
Lauren D NephewDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Bloomington, IN, 47405, USA. lnephew@iu.edu.

Funding

NIMHD NIH HHS NMIHD 1K23MD018090-01
6 · The paper itself

Abstract

backgroundHepatocellular carcinoma (HCC) is a serious consequence of chronic liver disease, with liver transplantation (LT) as the most durable curative option. However, significant disparities in access persist. Further, there is a lack of data on social determinants of health (SDOH) and disease-related barriers to HCC-LT pathway completion.

methodsThis retrospective cohort study included adults referred to a single center for LT with HCC from 2017 to 2021. SDOH exposures included race, ethnicity, gender, insurance type, area deprivation index (ADI), and marital status. Data from transplant database notes, including open-text fields documenting reasons for evaluation discontinuation, were used to identify and categorize reasons for failure to complete six predefined steps in the HCC-LT pathway. Multivariable logistic regression and competing risk analysis evaluated factors associated with waitlisting and survival.

resultsAmong 495 HCC patients referred for LT, 8.7% were Black and 57.2% were insured by Medicaid, with a mean ADI of 69.0 (± 21.1). Disease-related barriers (39.0%) and social barriers (35.6%) were common reasons for failing to complete the LT pathway. Public insurance (aOR 0.65, 95% CI 0.44-0.95) and being unmarried (aOR 0.60, 95% CI 0.40-0.88) were independently associated with a lower odd of waitlisting, and high ADI (aHR 1.01, 95% CI 1.00-1.02) was associated with mortality.

conclusionsInsurance type and marital status were associated with a failure to waitlist and ADI with survival. The SDOH were important barriers to completing the HCC-LT pathway. Targeted interventions are needed to support at-risk patients through the HCC-LT process.

Indexed as

Carcinoma, HepatocellularHealth Services AccessibilityLiver NeoplasmsLiver TransplantationSocial Determinants of HealthWaiting ListsAdultAgedFemaleHealthcare DisparitiesHumansMaleMiddle AgedRetrospective StudiesUnited StatesDisparitiesEthnicityHepatocellular carcinomaLiver transplantationRaceSocial economic status

Identifiers

PMID40764459
PMCPMC12909354

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.