Alcoholic liver disease overtakes HCV as top indication for liver transplant

  • JAMA Intern Med
  • 22 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • The proportion of liver transplants (LTs) for alcohol-associated liver disease (ALD) in the U.S. increased during 2002-2016, with 48% of the increase corresponding to decreased HCV-related LTs in the era of direct-acting antivirals (DAAs).
  • Long-term survival was lower for ALD-LT vs non-ALD-LT.

Why this matters

  • Increase in ALD-LT may reflect changing attitudes toward length of sobriety needed before transplant.

Study design

  • Observational study using data for 32,913 LT patients (median age, 54 years) from the United Network for Organ Sharing (Jan 2002-Dec 2016), including 9438 (28.7%) with ALD.
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases.

Key results

  • With HCV-LT excluded, proportion of ALD-LT rose 51.6%, from 24.2% in 2002 to 36.7% in 2016.
  • With HCV-LT included, proportion of ALD-LT increased 100%, from 15.3% in 2002 to 30.6% in 2016.
    • 48.4% absolute discrepancy was attributed to decreased HCV infections.
    • Greatest increase in ALD-LT occurred during 2010-2016 DAA era (18.6%-30.6%).
  • Unadjusted 10-year post-LT survival was lower for ALD-LT vs non-ALD-LT (63% [95% CI, 61%-64%] vs 68% [95% CI, 67%-69%]).
  • In multivariate analysis, ALD-LT was tied to increased risk for late death vs non-ALD-LT (aHR=1.11; P=.006), and lower odds of retransplantation (aHR=0.79; P=.002).

Limitations

  • Observational data.

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