Alcoholic Liver Disease Patients Listed for Liver Transplantation: An Overview from 2002-2017

Manasi Joshi, Elizabeth Godfrey, John Goss, Abbas Rana

Abstract


ALD patients comprise a larger proportion of listings for liver transplant (LT) than in the past, and represent a population undergoing demographic change in the United States.

 

This study examined the OPTN/UNOS transplantation waitlist STAR files from March 2002 - December 2017. All adults listed for LT were included (n=135,956). Yearly demographic trends in ALD-related listings and listing outcomes (transplantation vs. death on waitlist) were explored.

 

Alcoholic cirrhosis has increased from 4.3% of the LT candidates in 2002 to 8.3% in 2017. While alcoholic hepatitis accounted for only 0.64% of listings in 2017, this has doubled since 2004.

 

The proportion of women listed for ALD increased (21.8% in 2002 vs. 28.34% in 2017). Furthermore, proportionally fewer ALD listings are White patients (79.42% in 2002 vs. 75.66% in 2017). While the proportion of Hispanic LT candidates increased (12.87% vs. 15.94% p=0.00), proportionally, Hispanic ALD patients remained constant (15.68%, 15.84%).

 

Since 2015, the percentage of ALD patients on the waitlist receiving transplants increased (from 41% in 2014 to 45% and 49% in 2015 and 2016). This increase is more than the increase for patients transplanted for non-ALD indications (39% to 40% and 41%). Transplant-to-death ratio increased to 7.6 in 2017 in the ALD group but only to 4.3 in the non-ALD group.

 

This descriptive study provides an update on the relative prevalence of ALD in the LT population, demographic changes, and waitlist outcomes.


Keywords


Alcoholic Liver Disease; Liver Transplantation

References


Manthey, J., Shield, K., Rylett, M., et al. (2019). Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. The Lancet, 393(10190), 2493–2502. https://doi.org/10.1016/S0140-6736(18)32744-2

Axley PD, Richardson CT, Singal AK. Epidemiology of alcohol consumption and societal burden of alcoholism and alcoholic liver disease. Clinics in Liver Disease. 2019;23(1):39-50. doi:10.1016/j.cld.2018.09.011

Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2018;16(8):1356-1358. doi:10.1016/j.cgh.2017.11.045

Goldberg D, Ditah IC, Saeian K, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis orliver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152(5):1090-1099.e1. doi:10.1053/j.gastro.2017.01.003

Wang F-S, Fan J-G, Zhang Z, Gao B, Wang H-Y. The global burden of liver disease: the major impact of China. Hepatology. 2014;60(6):2099-2108. doi:10.1002/hep.27406

Gyongyi Szabo. (2018). Women and alcoholic liver disease — warning of a silent danger. Nature Reviews Gastroenterology & Hepatology, 15(5), 253–254. https://doi.org/10.1038/nrgastro.2018.8

U.S. Census Bureau. (2002, December). Statistical Abstract of the United States: 2002. Washington, DC: U.S. Government Printing Office.

United States Census Bureau. (2019, June). Quick facts- U.S., States, and Counties- Population Estimates. [Table].

Russ KB, Chen N-W, Kamath PS, Shah VH, Kuo Y-F, Singal AK. Alcohol use after liver transplantation is independent of liver disease etiology. Alcohol. 2016;51(6):698-701. doi:10.1093/alcalc/agw032

Lucey MR. Alcohol-associated cirrhosis. Clinics in Liver Disease. 2019;23(1):115-126. doi:10.1016/j.cld.2018.09.013


Full Text: PDF HTML

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.