The landscape of liver transplantation for patients with Alcohol-associated liver disease in USA

David M Vock; Vanessa Humphreville; Karthik V Ramanathan; Andrew B Adams; Nicholas Lim; Vinh H Nguyen; Jillian K Wothe; Srinath Chinnakotla

doi:10.1097/LVT.0000000000000394

The landscape of liver transplantation for patients with Alcohol-associated liver disease in USA

Liver Transpl. 2024 May 13. doi: 10.1097/LVT.0000000000000394. Online ahead of print.

Authors

David M Vock¹, Vanessa Humphreville², Karthik V Ramanathan², Andrew B Adams², Nicholas Lim³, Vinh H Nguyen⁴, Jillian K Wothe², Srinath Chinnakotla²

Affiliations

¹ Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN USA.
² Liver Transplant Program, Departments of Surgery.
³ Medicine, and.
⁴ Anesthesiology, University of Minnesota Medical School, Minneapolis, MN USA.

PMID: 38727598
DOI: 10.1097/LVT.0000000000000394

Abstract

Background/aims: Indications for liver transplants have expanded to include patients with alcohol-associated liver disease (ALD) over the last decade. Concurrently, the liver allocation policy was updated in February 2020 replacing the Donor Service Area with Acuity Circles (AC). The aim is to compare the transplantation rate, waitlist outcomes, and post-transplant survival of candidates with ALD to non-ALD and assess differences in that effect after the implementation of the AC policy.

Approach: Scientific Registry for Transplant Recipients data for adult liver transplant (LT) candidates was reviewed from the post-AC era (2/4/2020 - 3/1/2022) and compared with an equivalent length of time before AC were implemented.

Results: The adjusted transplant rates were significantly higher for those with ALD pre-AC, and this difference increased after AC implementation (transplant rate ratio comparing ALD to non-ALD=1.20, 1.13, 1.61, and 1.32 for MELD categories 37-40, 33-36, 29-32, 25-28, respectively, in the post-AC era, p <0.05 for all). The adjusted likelihood of death/removal from the waitlist was lower for ALD patients across all lower MELD categories (aSHR=0.70, 0.81, 0.84, 0.70 for MELD categories at list 25-28, 20-24, 15-19, 6-14, respectively, p <0.05). Adjusted post-transplant survival was better for those with ALD (aHR=0.81, p <0.05). Waiting list and post-transplant mortality tended to improve more for those with ALD since the implementation of AC but not significantly.

Conclusions: ALD is a growing indication for liver transplantation. Although ALD patients continue to have excellent post-transplant outcomes and lower wait list mortality, candidates with ALD have higher adjusted transplant rates, and these differences have increased after AC implementation.