22 Jan Changing Attitudes Toward Liver Transplant for Alcohol-Associated Liver Disease
MedicalResearch.com Interview with:
Norah Terrault, MD MPH
Department of Medicine
University of California San Francisco
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Rates of liver transplantation (LT) for alcohol-associated liver disease (ALD) are rising such that ALD recently became the most common reason for LT in the United States. Although some assume that the increase in LT for ALD is because LT for hepatitis C has declined since the advent of antiviral therapy, little research has been done to formally investigate this hypothesis, or other reasons for the increase.
This national registry study used the United Network for Organ Sharing database and included over 32,000 liver transplant recipients, including 9,438 patients with ALD. The main findings are that
1) liver transplantation for ALD has doubled in the past 15 years, but only 48% of the increase in LT for ALD can be explained by declining LT for hepatitis C;
2) Many liver transplantation centers require patients to be abstinent at least 6 months to be eligible for LT for alcohol-associated liver disease, but this is changing – our trends analysis strongly suggest that shifting attitudes of transplant providers to allow earlier LT for ALD are an important part of the increase in LT for ALD, and are variable across different geographic regions;
3) Late post- liver transplantation survival after 5-years is 11% lower for alcohol-associated liver disease (vs. non-ALD).
MedicalResearch.com: What should readers take away from your report?
Response: Changing attitudes regarding liver transplantation for acute alcoholic hepatitis may be having broad effects on LT for alcohol-associated liver disease, as more LT providers believe that it is justified to pursue earlier LT for ALD. As attitudes continue to change with more data to suggest that early LT for ALD can be undertaken with acceptable outcomes, we may see further increases in liver transplantation for ALD in future years. Since attitudes are provider-specific, and there is no national transplant policy for LT eligibility in terms of pre-LT abstinence requirements, this study suggests that variable policies and provider attitudes may be leading to inequity in healthcare access for alcohol-associated liver disease patients in need of liver transplantation.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Given the significant increase in liver transplantation for alcohol-associated liver disease, which was different across regions, there would be value in a national policy to guide the management of LT for ALD. It is unclear why late survival for ALD is inferior for non-ALD, but other studies have shown recurrent alcohol use, malignancy, and infections to be important causes of late death after liver transplantation — these should be specifically investigated in future studies of liver transplantation for ALD.
Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. JAMA Intern Med. Published online January 22, 2019. doi:10.1001/jamainternmed.2018.6536
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