Webb GJ, et al. - The clinicians strived to evaluate trends in numbers and demographics patients awaiting liver transplant for primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH) using waitlists for liver transplantation. They found that among patients with autoimmune liver diseases, PSC had become the leading indication for liver transplantation. Possibly due to increased treatment with ursodeoxycholic acid, numbers of patients with PBC placed on waitlists, and the ratio of women: men with PBC, each decreased by almost 50%. They observed differences in age, sex, disease severity scores within groups of patients on the transplant waitlisted for PBC, PSC, or AIH, and ethnicity between diseases and countries that require further study.

• From January 1, 1995, through December 31, 2014, the clinicians gathered data from United Kingdom (UK) and United States (US) national registries for all adults on liver transplant waitlists.
• They examined data on patients with PBC (n=1434 in the UK and n=5598 in the US), PSC (n=1093 in the UK and n=6820 in the US), and AIH (n=538 in the UK and n=4949 in the US).
• They adjusted numbers of listings per year to the estimated populations during each year.
• They used regression analyses to investigate trends and used comparative statistics to assess differences in individual characteristics among groups.

• Listings for PBC were 1.2 and 1.0 per million population per year in the UK and the US respectively over the total study period.
• For PSC, the listings were 0.9 and 1.2 per million population per year.
• For AIH they were found to be 0.5 and 0.8 per million population per year.
• Numbers of listings for PBC decreased by 50% in both countries over the period studied; changes in numbers of listings for PSC and AIH were smaller and not consistent between countries.
• In both countries, PSC had become the leading indication for liver transplantation in patients with autoimmune liver diseases by 2014.
• At time of listing, median patient ages were lower than those reported as median age of diagnosis for AIH and PBC.
• From 1995 through 2014, the ratio of women:men with PBC decreased by almost 50%.
• In both countries, men with PSC were placed on the waitlist with higher disease severity scores than women.
• Those of black race were under-represented on waitlists from both countries among patients with PBC.
• Hispanics were under-represented on waitlists in the US among patients with PSC.
• For all diseases, patients of non-white races were placed on waitlists at younger ages.
• Age differences in waitlist placement varied by up to 10 years, depending on race, among patients with PBC.