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Temporal Trends Associated With the Rise in Alcoholic Liver Disease-related Liver Transplantation in the United States

Cholankeril, George, MD1; Gadiparthi, Chiranjeevi, MD2; Yoo, Eric R., MD3; Dennis, Brittany B., PhD4; Li, Andrew A., MD5; Hu, Menghan6; Wong, Katherine, MD1; Kim, Donghee, MD, PhD1; Ahmed, Aijaz, MD1

doi: 10.1097/TP.0000000000002471
Original Clinical Science—Liver
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Background In the United States, alcoholic liver disease (ALD) has recently become the leading indication for liver transplantation.

Methods Using the United Network for Organ Sharing registry, we examined temporal trends in adult liver transplant waitlist (WL) registrants and recipients with chronic liver disease (CLD) due to ALD from 2007 to 2016.

Results From 2007 to 2016, ALD accounted for 20.4% (18 399) of all CLD WL additions. The age-standardized ALD WL addition rate was 0.459 per 100 000 US population in 2007; nearly doubled to 0.872 per 100 000 US population in 2016 and increased with an average annual percent change of 47.56% (95% confidence interval, 30.33% to 64.72%).The ALD WL addition rate increased over twofold among young (18-39 years) and middle-aged (40-59 years) adults during the study period. Young adult ALD WL additions presented with a higher severity of liver disease including Model for End-Stage Liver Disease score compared to middle aged and older adults (≥60 years). The number of annual ALD WL deaths readily rose from 2014 to 2016, despite an overall annual decline in all CLD WL deaths. Severe hepatic encephalopathy, low body mass index (<18.5) and diabetes mellitus were significant predictors for 1-year WL mortality.

Conclusions Alcoholic liver disease–related WL registrations and liver transplantation have increased over the past decade with a disproportionate increase in young and middle-aged adults. These subpopulations within the ALD cohort need to be evaluated in future studies to improve our understanding of factors associated with these alarming trends.

1 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.

2 Division of Gastroenterology and Hepatology, Saint Peter's University Hospital, New Brunswick, NJ.

3 Department of Internal Medicine, Santa Clara Valley Medical Center, Santa Clara, CA.

4 Department of Medicine, Saint Georges Hospital, University of London, London, United Kingdom.

5 Department of Medicine, Stanford University School of Medicine, Stanford, CA.

6 Department of Biostatistics, Brown University, Providence, RI.

Received 6 July 2018. Revision received 10 September 2018.

Accepted 25 September 2018.

All authors approved the final version of the article submitted and have agreed to be accountable for all aspects of the work.

The authors declare no funding or conflicts of interest.

G.C. was responsible for study concept and design, acquisition of data, analysis and interpretation of data, drafting of the article, critical revision of the article for important intellectual content and statistical analysis. C.G., E.R.Y., B.B.D., A.A.L., K.W., M.H., and D.K. were responsible for study concept and design, analysis and interpretation of data, critical revision of the article for important intellectual content and statistical analysis, and approval of the final draft article. A.A. was responsible for study concept and design, analysis and interpretation of data, critical revision of the article for important intellectual content and supervision of research project.

Correspondence: Aijaz Ahmed, MD, Division of Gastroenterology and Hepatology Stanford University School of Medicine, 750 Welch Rd 210, Palo Alto, CA 94304. (aijazahmed@stanford.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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