Diagnosis at a Safety Net Hospital Is Not Independently Associated With Reduced Liver Transplant Access or Increased Mortality in Milan-Eligible Hepatocellular Carcinoma Patients: Analysis of the United States Safety Net Collaborative.

Authors

Lydia Pan, Conor Donnelly, Maria C Russell, Neha Goel, Adam Yopp, Cary Hsu, Eric Silberfein, Alejandro Torres-Hernandez, Ann Lee, United States Safety Net Collaborative

Published in

The Journal of surgical research. Volume 328. Pages 159-166. Oct 22, 2026. Epub Oct 22, 2026.

Abstract

Liver transplantation improves survival for hepatocellular carcinoma (HCC). We aim to evaluate the impact of diagnosis location on transplant access and mortality among patients diagnosed at safety net hospitals (SNHs) compared with academic medical centers (AMCs).
Using the United States Safety Net Collaborative database (2012-2014), we conducted a multicenter retrospective study of Milan-eligible HCC patients diagnosed at AMCs or SNHs, balancing using inverse probability of treatment weighting.
Among 508 patients, 38.2% were diagnosed at SNHs. SNH patients lived in areas with lower median incomes ($41,905 versus $55,681) and fewer were White (36.9% versus 73.6%) or privately insured (11.3% versus 38.2%) (all P < 0.001). Despite similar tumor burden, the 5-y incidence of transplantation was higher for AMC patients (42.0% versus 13.7%, P < 0.0001). However, after weighting for differences in patient characteristics, SNH diagnosis was not independently associated with transplantation (wHR 0.73, 0.21-2.51; P = 0.6). Unadjusted 5-y mortality was higher among SNH patients (41.0% versus 30.5%, P = 0.07), but SNH diagnosis was not independently associated with mortality after weighting (wHR 1.96, 0.76-5.06, P = 0.2). When censoring at transplantation, mortality was similar between SNH and AMC patients, suggesting comparable pretransplant care.
Milan-eligible HCC patients diagnosed at SNH experience similar transplant access and mortality when weighted for case mix. Disparities in transplantation may be driven by differences in the populations served by SNHs rather than the site of diagnosis itself.

PMID:
42913266
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.

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