Alcoholic Liver Disease Patients Listed for Liver Transplantation: An Overview from 2002-2017

Abstract

ALD patients comprise a larger proportion of listings for liver transplant (LT) than in the past, and represent a population undergoing demographic change in the United States. This study examined the OPTN/UNOS transplantation waitlist STAR files from March 2002 - December 2017. All adults listed for LT were included (n=135,956). Yearly demographic trends in ALD-related listings and listing outcomes (transplantation vs. death on waitlist) were explored. Alcoholic cirrhosis has increased from 4.3% of the LT candidates in 2002 to 8.3% in 2017. While alcoholic hepatitis accounted for only 0.64% of listings in 2017, this has doubled since 2004. The proportion of women listed for ALD increased (21.8% in 2002 vs. 28.34% in 2017). Furthermore, proportionally fewer ALD listings are White patients (79.42% in 2002 vs. 75.66% in 2017). While the proportion of Hispanic LT candidates increased (12.87% vs. 15.94% p=0.00), proportionally, Hispanic ALD patients remained constant (15.68%, 15.84%). Since 2015, the percentage of ALD patients on the waitlist receiving transplants increased (from 41% in 2014 to 45% and 49% in 2015 and 2016). This increase is more than the increase for patients transplanted for non-ALD indications (39% to 40% and 41%). Transplant-to-death ratio increased to 7.6 in 2017 in the ALD group but only to 4.3 in the non-ALD group. This descriptive study provides an update on the relative prevalence of ALD in the LT population, demographic changes, and waitlist outcomes.