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Alcoholic liver disease overtakes HCV as leading indication on liver waitlist

An analysis of the liver waitlist revealed that as the total number of liver transplantations in the U.S. has increased each year, alcoholic liver disease has become the leading indication over hepatitis C.

“Data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of [direct-acting antiviral]-based regimens. Despite the downtrend, primary diagnosis of HCV remained the most common etiology for liver transplantation in the U.S. until the end of 2015,” George Cholankeril, MD, and Aijaz Ahmed, MD, from Stanford University School of Medicine, wrote. “In 2016, ALD became the leading indication for LT waitlist additions in the U.S. by surpassing HCV.”

Cholankeril and Ahmed accessed data from Jan. 1, 2012, to Dec. 31, 2016, in the United Network for Organ Sharing database to evaluate the current liver transplantation indication trends in the U.S.

Additionally, they performed sub-analyses of waitlist indication trends from 2015 to 2016 and from Jan. 1, 2017, to Oct. 31, 2017.

The annual LT waitlist additions and surgeries due to chronic liver disease — including HCV, alcoholic liver disease and nonalcoholic steatohepatitis — increased by 2.1% in 2012 and by 7.6% in 2016.

Chronic HCV was the leading etiology for LT between 2012 and 2015. During 2016, the researchers observed an 18% decline in annual percentage of LT surgeries for HCV.

In 2016, ALD (30%) and NASH (21%) outpaced and overtook HCV as the first and second leading chronic liver indications for liver transplantations, respectively. ALD remained the leading indication for LT among patients with concomitant ALD and HCV.

From 2015 to 2016, patients with ALD as indication for LT were significantly younger (range, 47-51 years) than those with HCV (range, 55-63 years) or NASH (range, 54-65 years) as indication (P < .001). Further, those with ALD as indication had significantly higher median MELD scores (21; range, 15-30) at listing compared with patients who had HCV (14; range, 10-21) and NASH (17; range, 13-24) as indications (P < .001). Patients with ALD also had higher MELD scores at time of surgery compared with HCV and NASH.

The sub-analysis in 2017 continued to reveal ALD as the leading indication for LT waitlist additions and surgeries.

“ALD is a well-established CLD that has been increasing in prevalence without any well-coordinated effort to tackle it,” the researchers concluded. “These data fore-warned an increase in alcohol-related chronic comorbidities, including ALD. Similarly, NASH continues to grow as an indication for liver transplantation. Measures are needed to aggressively address these ominous trends in the rising rates of ALD and NASH-related liver transplantation.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.