- 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.
- 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.
- 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).
- Observational data.