Objectives To synthesise the literature examining how social determinants of health (SDOH) influence access to liver transplantation across the pre-transplant continuum, including referral, evaluation and waitlist entry.Design Scoping review.Data sources Ovid MEDLINE, Ovid Embase, Ovid Emcare Nursing, Cochrane Database of Systematic Reviews and CENTRAL were searched for studies published between January 2000 and July 2025. The search was conducted on 18 July 2025.Eligibility criteria English-language qualitative, quantitative and mixed-methods studies examining disparities in referral, evaluation or waitlisting for liver transplantation were included. Eligible disparity domains included gender, race/ethnicity, socioeconomic status, geography and substance use. Studies focused exclusively on post-transplant outcomes, non-liver transplantation, conference abstracts, editorials and review articles were excluded.Data extraction and synthesis Screening was performed independently in duplicate. Data were extracted using a standardised template and synthesised narratively by disparity domain.Results 88 studies identified disparities across the pre-transplant continuum. Gender disparities were linked to the model for end-stage liver disease (MELD)-based underestimation of renal dysfunction and body size and height thresholds that reduce the likelihood of being listed. Racial and ethnic disparities were observed, with Black, Hispanic/Latinx and Indigenous patients under-represented on waitlists, referred later and disproportionately excluded for non-medical reasons. Socioeconomic disparities were driven by insurance status, financial barriers and unequal access to high-volume transplant centres and living donor transplantation. Geographic disparities included lower referral and listing rates in rural or underserved regions. Substance use-related disparities reflected heterogeneous abstinence requirements and subjective assessments of adherence and suitability. Intersecting identities demonstrated compounded disadvantage when race, socioeconomic status, gender and geography overlapped.Conclusions SDOH significantly influence referral, evaluation and waitlist entry for liver transplantation. These disparities are multifactorial, systemic and intersecting. Greater attention to equity-focused transplant policy and standardised referral and evaluation practices is needed to improve access to liver transplantation.
Introduction The clinical course of inflammatory bowel disease (IBD) is highly heterogeneous, yet the biological mechanisms underlying this variability, along with robust predictive biomarkers of disease course and treatment response, remain elusive. Most existing multi-omic cohorts recruit patients after IBD diagnosis and following therapeutic exposure, limiting the ability to distinguish between primary disease biology and downstream consequences of chronic inflammation and/or treatment. There is, therefore, a critical unmet need for large-scale, treatment-naïve inception cohorts integrating deep clinical phenotyping with longitudinal multi-omic profiling from the point of IBD diagnosis.Methods and analysis Open-IBD is a prospective, multicentre UK inception cohort study recruiting up to 2000 adults referred with suspected IBD, prior to diagnosis and initiation of IBD-specific therapy. Baseline assessment includes detailed clinical metadata collection, patient-reported outcome measures and collection of blood, stool and intestinal biopsy samples. 1000 participants subsequently diagnosed with IBD will be followed for up to 48 months, with repeated clinical assessments, questionnaires and biosampling. Participants not diagnosed with IBD will form a symptomatic control cohort with longitudinal clinical record review. Multi-omic analyses will include human genetics, single-cell transcriptomics of blood and intestinal tissue, stool and intestinal mucosal microbiome characterisation, metabolomics and proteomics. Integrated longitudinal clinical and multi-omic datasets will be generated to characterise early-stage treatment-naïve IBD, identify biomarkers associated with long-term outcomes and nominate causal factors driving IBD pathophysiology.Ethics and dissemination Ethical approval has been obtained from the Wales Research Ethics Committee 1 (24/WA/0338). All participants provide informed consent before enrolment. Recruitment is ongoing. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and lay summaries.Study registration number ISRCTN15535639.
Objective To evaluate the influence of socioeconomic deprivation and rurality on colon capsule endoscopy (CCE) performance and downstream management in a remote National Health Service (NHS) population.Methods We performed a secondary analysis of 2480 patients undergoing CCE within NHS Highland between 2019 and 2024 using data from the ScotCap registry. Primary outcomes were bowel preparation adequacy and CCE completion. The secondary outcome was follow-up pathway (endoscopic vs non-endoscopic). Predictor variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile and Urban–Rural Classification (URC). Multivariable logistic regression was used to estimate ORs with 95% CIs.Results The mean age was 59.3 years (SD 12.4) and 1379/2480 (55.6%) patients were female. Adequate bowel preparation was achieved in 1787/2480 (72.1%) patients, CCE was completed in 1669/2480 (67.3%), and endoscopic follow-up occurred in 1421/2480 (57.3%). Neither SIMD nor URC was associated with bowel preparation adequacy, CCE completion or follow-up pathway (all p>0.05). Female sex was independently associated with inadequate bowel preparation (OR 1.70, 95% CI 1.42 to 2.04; p<0.001) and CCE incompletion (OR 1.62, 95% CI 1.36 to 1.93; p<0.001). Increasing age was associated with reduced odds of non-endoscopic follow-up (OR 0.99, 95% CI 0.98 to 1.00; p=0.01). Inadequate bowel preparation was strongly associated with subsequent endoscopic investigation (OR 0.18, 95% CI 0.12 to 0.27; p<0.001).Conclusions This is the largest study evaluating socioeconomic deprivation and rurality in CCE. Neither influenced CCE performance or downstream management. Instead, patient factors, including sex, age and bowel preparation quality, were the primary determinants of outcomes. These findings support CCE as an equitable diagnostic modality across diverse populations and support the expansion of community and home-based services.
Introduction Pseudomyxoma peritonei (PMP) is a rare malignancy usually originating from a perforated appendix tumour. Potentially curative treatment involves cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy, commonly mitomycin-C (MMC). Different regimens of MMC are used across the world, with little convincing evidence for which regimen best balances favourable clinical outcomes against side effects and cost. The aim of this trial is to compare two dosing regimens of MMC during CRS.Methods and analysis The HIPEC-PMP trial is an individually randomised, parallel group, single-blind, non-inferiority trial that will randomise patients (1:1) with PMP who are amenable to complete cytoreduction to one of two established regimens, either low-dose MMC (10 mg/m2 for 60 min) or high-dose MMC (35 mg/m2 for 90 min) to test the non-inferiority of low-dose MMC. A Bayesian design is used to incorporate prior information on each dose, with a principled approach to discount historical data if it is markedly different from the trial data. Participants must have a clinical and/or radiological diagnosis of PMP from a primary mucinous epithelial tumour of the appendix that is amenable to complete cytoreduction and will be recruited from a single specialist centre. Participants will be followed up for a minimum of 2 years. The primary endpoint is disease-free survival at 2 years, and secondary endpoints are overall survival, adverse events, quality of life and cost-effectiveness. A Bayesian analysis will be used to determine the probability that 2-year recurrence rates are within 10% to determine non-inferiority. The trial has a target sample size of 176.Ethics and dissemination The study is sponsored by the University of Southampton, coordinated by the Cancer Research UK Southampton Clinical Trials Unit, and open to recruitment at the Peritoneal Malignancy Unit at the Hampshire Hospitals Foundation Trust. The trial protocol has received the favourable opinion of the London-Westminster Research Ethics Committee (REC 24/LO/0692), as well as the necessary approvals from the Medicines and Healthcare products Regulatory Agency and NHS Health Research Authority. Informed consent is required before any trial specific procedures are undertaken. It is intended that the results of the study will be disseminated via publication in peer-reviewed scientific journals, conference presentations and submission to regulatory authorities.Trial registration number NCT06513065.
