TY - JOUR
T1 - Liver transplantation for alcoholic hepatitis in the United States
T2 - Excellent outcomes with profound temporal and geographic variation in frequency
AU - Cotter, Thomas G.
AU - Sandıkçı, Burhaneddin
AU - Paul, Sonali
AU - Gampa, Anuhya
AU - Wang, Jennifer
AU - Te, Helen
AU - Pillai, Anjana
AU - Reddy, Kapuluru G.
AU - di Sabato, Diego
AU - Little, Ester C.
AU - Sundaram, Vinay
AU - Fung, John
AU - Lucey, Michael R.
AU - Charlton, Michael
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/3
Y1 - 2021/3
N2 - Medical-refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol-associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39 455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5-fold, from 28 in 2014 to 138 in 2019, varying 8-fold between UNOS regions. Three transplant centers accounted for 50%-90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean = 39.4 years), had higher MELD scores (mean = 36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P <.05). One- and 5-year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium-term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.
AB - Medical-refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol-associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39 455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5-fold, from 28 in 2014 to 138 in 2019, varying 8-fold between UNOS regions. Three transplant centers accounted for 50%-90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean = 39.4 years), had higher MELD scores (mean = 36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P <.05). One- and 5-year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium-term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.
KW - alcoholism and substance abuse
KW - clinical research/practice
KW - liver allograft function/dysfunction
KW - liver disease
KW - liver transplantation/hepatology
KW - Organ Procurement and Transplantation Network (OPTN)
KW - United Network for Organ Sharing (UNOS)
UR - http://www.scopus.com/inward/record.url?scp=85089390341&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089390341&partnerID=8YFLogxK
U2 - 10.1111/ajt.16143
DO - 10.1111/ajt.16143
M3 - Article
C2 - 32531107
AN - SCOPUS:85089390341
SN - 1600-6135
VL - 21
SP - 1039
EP - 1055
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -