Alcohol-associated Liver Disease Is Now the Most Common Indication for Liver Transplant Waitlisting Among Young American Adults

Abstract

Background. Mortality from cirrhosis is increasing and is the highest among young adults with alcohol-associated liver disease (ALD). The aim of this study was to describe rates of liver transplant (LT) waitlisting stratified by age, sex, and cirrhosis etiology. Methods. Retrospective population-based study from 2003 to 2018 using the Scientific Registry of Transplant Recipients database. Adults newly registered on the LT waitlist were included, and age at listing was dichotomized to ±40 y. Annual standardized incidence proportions of LT waitlisting by age group, sex, and etiology were calculated using census data. Changes in annual rates were described with Poisson regression. Results. A total of 209 399 unique individuals were included, 10 326 (5%) <40 y at listing. In those <40 y of age, listing increased most for ALD (4-fold increase) followed by nonalcoholic fatty liver disease (NAFLD; 2-fold increase). Compared to young adult males, young females were more likely to be listed for ALD and less likely to be listed for NAFLD. In those ≥40 y of age, listings increased most for ALD (2-fold increase) and NAFLD (2-fold increase). Hepatitis C virus increased from 2003 to 2013 and declined post-2014 in the ≥40-y age group. Conclusions. LT waitlisting is increasing substantially in young Americans, driven primarily by ALD. These data support ongoing efforts to identify adolescents and young adults with early stages of ALD where interventions can be implemented to prevent the development of cirrhosis and liver-related complications.

ACG Clinical Guideline: Alcohol-Associated Liver Disease

“…Important advances in our understanding of ALD have occurred, including (i) insights into the natural history and prevalence Alcohol contributes to approximately 48% of cirrhosis-related hospitalizations and more than 40% of listings for LT in the United States (7)(8)(9)(10). The LT activity increased by .50% for AH with a 4-fold increase between 2003 and 2018 among those aged younger than 40 years (7,8).…”

“…Important advances in our understanding of ALD have occurred, including (i) insights into the natural history and prevalence Alcohol contributes to approximately 48% of cirrhosis-related hospitalizations and more than 40% of listings for LT in the United States (7)(8)(9)(10). The LT activity increased by .50% for AH with a 4-fold increase between 2003 and 2018 among those aged younger than 40 years (7,8). An increase in LT for ALD has been evident since 2014, reflecting a decreased LT need for hepatitis C virus (HCV) because of availability of direct-acting antivirals, a true increase in the incidence of ALD, and wider acceptance of LT for severe AH (11).…”

Caracterización clínico-epidemiológica de los pacientes sometidos a trasplante hepático por cirrosis alcohólica en el Hospital Pablo Tobón Uribe de Medellín entre 2004 y 2015

“…La enfermedad alcohólica hepática (EAH) es la causa más común de enfermedad hepática terminal (EHT) en los países occidentales [1][2][3][4]; de hecho, el 44 % de todas las muertes por cirrosis son atribuidas al consumo de alcohol [5]. En Estados Unidos y Europa, aproximadamente entre el 17 % al 25 % de los trasplantes hepáticos son indicados por EAH, incluso en algunos países es registrada como una de las dos indicaciones más comunes de trasplante or-totópico hepático (TOH) [2][3][4][5][6][7]; datos más recientes relacionan la EAH como la causa más común de trasplante hepático en Estados Unidos, resaltando la importancia de identificar tempranamente la adicción y prevenir sus complicaciones [8].…”

Efficacy of Autologous Skeletal Myoblast Cell Sheet Transplantation for Liver Regeneration in Liver Failure

“…Liver diseases, such as hepatitis virus infection and alcoholic and nonalcoholic steatohepatitis, can lead to severe liver cirrhosis, resulting in liver failure, an irreversible and life-threatening state. [1][2][3] The only treatment for severe liver failure is currently liver transplantation, but donors for liver transplantation are lacking, 4 and there are many problems with transplantation, including technical difficulties and highly invasive surgery, the risk of life-threatening postoperative complications, requirement for immunosuppression after the transplantation, and declining quality of the posttransplant life because of the immunosuppressive status. Thus, liver transplantation is not indicated for all cases with liver failure, suggesting a need to develop novel new therapeutic interventions for liver failure.…”