Rise in liver failures, transplants highlights need to curb high-risk drinking in all ages
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CHICAGO — Researchers reported a 262% increase in liver transplantation for acute-on-chronic liver failure in older patients from 2005 to 2021, with alcohol-related liver disease becoming the leading cause during the COVID-19 pandemic.
“Data on liver transplantation for acute-on-chronic liver failure (ACLF) in adults older than 65 years are currently limited,” Joseph J. Alukal, MD, assistant clinical professor in the department of internal medicine at the University of California Riverside School of Medicine, told Healio. “The underlying etiology of ACLF varies between older and younger patients, however, this has not been explored in detail.”
Alukal continued: “The impact of COVID-19 pandemic on older adults with chronic liver disease or cirrhosis is not well defined.”
To examine LT trends for ACLF among adults older and younger than 65 years, Alukal and colleagues identified patients from the UNOS database who underwent LT between 2005 and 2021. Researchers grouped causes of cirrhosis into alcohol-related liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C virus, cryptogenic cirrhosis and primary biliary cirrhosis (PBC) or primary sclerosing cirrhosis (PSC) and divided transplant years into the period before direct-acting antivirals (2005-2013), the DAA era (2014-2019) and the COVID-19 pandemic (2020-2021).
According to results presented at Digestive Disease Week, 2,142 older patients (≥ 65 years) underwent LT for ACLF from 2005 to 2021. The top etiologies were NASH (26%) followed by ALD (25%), HCV (10%) and PBC with PBS (8%). Researchers further reported that the number of older patients undergoing LT for ACLF jumped from 66 in 2005 to 239 in 2021 — a 262% increase.
Results also showed that 16,931 younger patients underwent LT for ACLF during the same period, with an increase of 194% from 2005 (n = 648) to 2021 (n = 1,908). The leading etiologies among this population were ALD (44%), HCV (15%) and NASH (10%).
In the pre-DAA era, ALD (20%) was the leading cause of underlying ACLF among older patients, which shifted to NASH during the DAA era and ALD during the 2020 pandemic year. Among younger patients, the leading etiology in the pre-DAA era was HCV followed by ALD in the DAA era. Researchers noted ALD was responsible for 62% and 68% of all LTs in younger patients in years 2020 and 2021, respectively, during the COVID-19 era.
“Our study illustrates the changing etiology of underlying cirrhosis in those with ACLF,” Alukal said. “In younger patients, alcohol-ACLF continues to rise at an alarmingly high rate. Based on our results, we recommend that urgent public health policies must be implemented to curb high-risk drinking across all age groups — both young and older.”
He added, “Future research should focus on developing pharmacotherapy against alcohol-use disorder that are safe and effective.”
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Alukal J, et al. Abstract 332: Changing trends in the etiology of acute-on-chronic liver failure (ACLF) as an indication for liver transplant. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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