The study has
also highlighted that there are regional geographic variations in the liver
transplant rates for
Dr. Brian P.
Lee, a Gastroenterology and Hepatology Fellow at UCSF and the lead author of
the study has said that, "This study
suggests that there may be value in a national policy for liver transplant in
alcohol-associated liver disease, to eliminate any potential inequity in health
care access for liver transplant related to the patient's geography and the
transplant center's policy on alcohol abstinence prior to transplant."
added that, "The liver transplant
landscape is changing and multiple factors must be taken into account when
considering future trends and policy."
times ALD has replaced hepatitis C to
become the most common source for liver transplants in the U.S.
such as flexibility around the six-month abstinence rule are most likely to
have caused this change in scenario. On the other hand, hepatitis C rates have
significantly declined after adopting antiviral therapy.
Alcoholism in the U.S
national epidemiology study in the Journal
of the American Medical Association (JAMA)
showed that the prevalence of
harmful drinking among Americans had increased considerably. The disorder was
more pronounced in women and disadvantaged socioeconomic populations. This is
also an indicator of the
escalation of many chronic comorbidities like ALD where
alcohol use plays a substantial role.
In general, a
candidate needing a transplant is required to abstain from alcohol for a
minimum of six months to be considered eligible for surgery. The practice of
following the 'six-month rule,' though common, but subjective, has declined
since 2011. Dr. Lee explains that this happened following a breakthrough
European study showing that liver transplants for patients with severe
alcoholic hepatitis could still be successful without the minimum sobriety
Dr. Lee and
his team analyzed 32,913 liver transplant recipients from 2002 to 2016 in the
United Network for Organ Sharing (UNOS) database. Of this, 9,438 were ALD
patients and 23,475 were non-ALD. Between 2002 and 2010 (a year before the
European study), the share of ALD transplants had increased from 24.2 percent
to 27.2 percent respectively.
2016, it had gone up to 36.7 percent. The proportions of transplant for ALD,
including the hepatitis
virus recipients were: 15.3 percent in 2002, 18.6 percent in 2010
and 30.6 percent in 2016, which is a 100 percent increase.
Geographical Variations in ALD Transplants
team has also identified variations in regional increases in transplants for
ALD among the 11 UNOS regions. All of these regions witnessed increases in the
proportion of liver transplant for ALD between 2010 and 2016.
- Region 2, comprising of Delaware, D.C., Maryland, New Jersey,
Pennsylvania, West Virginia, Northern Virginia and Region 4 -
Oklahoma, Texas saw the largest increase in ALD transplant.
- The smallest of
increases were noticed in Region
3: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Puerto
Rico and Region 10 - Indiana, Michigan.
Findings and Recommendations
team has observed that despite the significant increase in liver transplants
for ALD, when it comes to access to transplants, these patients are still at a
48 percent of liver-related deaths are a result of ALD, a
number that is still higher than the proportion of liver transplants.
mentions that for ALD patients the
survival rates beyond five years were 11 percent lower, despite the short-term
rates being the same as that of the non-ALD transplants.
Terrault, a UCSF Health Hepatologist and Professor of Medicine at UCSF and the
senior author of the study has remarked: "Early liver transplant for ALD recipients without a mandated
sobriety period leads to a higher proportion of patients with ALD being
prioritized for transplant over non-ALD patients."
She added, "Since liver transplant policy is decided at
a center level and may be incentivized by regional competition, there can be
significant regional disparities, potentially leading to inequity to transplant
access. We hope our results encourage action towards a national transplant
policy for ALD."
study, as part of another multicenter research, Dr. Lee and his team at UCSF
have developed a new tool referred to as the 'SALT'
Sustained Alcohol use post-Liver Transplant
. With 95 percent effectiveness,
'SALT' could be used to identify suitable candidates for transplant, ideally
patients with alcoholic hepatitis who were at low risk for sustained alcohol
use after transplant.
- Liver Transplants Double for Alcohol-Related Liver Disease - (https://www.ucsf.edu/news/2019/01/413096/liver-transplants-doubles-alcohol-related-liver-disease)