Lee BP, et al. - In this multicenter, prospective, national cohort study, researchers analyzed the trends and long-term outcomes of liver transplant for alcohol-associated liver disease (ALD) in the United States between 2002 and 2016. According to the findings, a decrease in liver transplant for hepatitis C virus infection was reported in association with 48% of the increase in liver transplant for alcohol-associated liver disease. The use of liver transplant for ALD may be impacted by changing attitudes regarding liver transplant for acute alcoholic hepatitis. Compared to liver transplant recipients with non-ALD indications, an inferior late survival was observed among liver transplant recipients with ALD. Regional differences were noted that were indicative of heterogeneity in policies toward liver transplant for ALD.

Methods

• This was a multicenter, prospective, national cohort study.
• Researchers used data from the United Network for Organ Sharing database.
• They assessed all liver transplants performed in the United States between January 1, 2002, and December 31, 2016.
• The main outcomes and measures included national and regional trends in liver transplant for ALD, with a sensitivity analysis with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) included, and early (≤90 days after liver transplant) and late (>90 days after liver transplant) patient and graft survival.

Results

• This study included 32,913 patients, including 9,438 with ALD and 23,475 without ALD (patients who had HCV infection and HCC indications were excluded).
• Those with ALD and those without ALD had median age 54 years (interquartile range, 47-60 years) and 54 years (interquartile range, 44-61 years), respectively.
• More frequently male (7197 of 9438 [76.2%] vs 11 767 of 23 475 [50.1%]; P < .001) and white (7544 [80.0%] vs 17 251 [73.5%]; P < .001) patients presented with ALD (vs non-ALD).
• An increased proportion of liver transplants for ALD was noted, ranging from 24.2% (433 of 1791) in 2002 to 27.2% (556 of 2044) in 2010 and 36.7% (1253 of 3419) in 2016.
• Regarding proportions of liver transplant for ALD, with HCV infection included, the values were 15.3% in 2002, 18.6% in 2010, and 30.6% in 2016, representing a 100% increase in liver transplant for ALD, of which 48% was related to a decrease in HCV infection as an indication for liver transplant.
• Regional heterogeneity was observed with respect to the magnitude of increase in ALD.
• The magnitude of increase in ALD was found to be related to changes in patient characteristics suggestive of alcoholic hepatitis: decreasing age (χ² = 36.5; P = .005) and increasing model for end-stage liver disease score (χ² = 69.1; P < .001).
• For ALD vs non-ALD, the observed cumulative unadjusted 5-year posttransplant survival was 79% (95% CI, 78%-80%) vs 80% (95% CI, 79%-80%), respectively, and cumulative unadjusted 10-year posttransplant survival was 63% (95% CI, 61%-64%) vs 68% (95% CI, 67%-69%) for non-ALD (P = .006), respectively.
• In multivariable analysis, increased risk of late death after liver transplant was reported in association with ALD (adjusted hazard ratio, 1.11; 95% CI, 1.03-1.20; P = .006).