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. 2020 Oct 8;6(11):e612.
doi: 10.1097/TXD.0000000000001051. eCollection 2020 Nov.

Increase in Alcoholic Hepatitis as an Etiology for Liver Transplantation in the United States: A 2004-2018 Analysis

Nabil Noureddin  1 , Ju Dong Yang  2   3 , Naim Alkhouri  4 , Samantha M Noreen  5 , Alice E Toll  5 , Tsuyoshi Todo  6 , Walid Ayoub  2   3 , Alexander Kuo  2   3 , Georgios Voidonikolas  6 , Honore G Kotler  6 , Michalyn D Pelphrey  3 , Brenda J Durand  3 , Kambiz Kosari  6 , Todd V Brennan  6 , Irene Kim  6 , Andrew S Klein  6 , Ekihiro Seki  2 , Nicholas N Nissen  6 , Shelly C Lu  2 , Vinay Sundaram  2   3 , Mazen Noureddin  2   3
Affiliations

Increase in Alcoholic Hepatitis as an Etiology for Liver Transplantation in the United States: A 2004-2018 Analysis

Nabil Noureddin et al. Transplant Direct. .

Abstract

Background: Changing opinions on the alcohol abstinence requirement have led to increased liver transplantation (LT) for alcoholic hepatitis (AH). We aimed to determine the trend in LT for AH in the United States and overall and graft survival rates.

Methods: Adult liver-alone and liver-kidney registrations added to the Organ Procurement and Transplantation Network waiting list between 2004 and 2018 were divided into 3 periods (2004-2009, 2010-2013, 2014-2018). Kaplan-Meier survival models illustrated patient and graft survival.

Results: Between 2004 and 2018, 529 AH patients were registered for and 254 received LT. By periods, 116, 73, and 340 patients were registered for and 49, 17, and 188 patients received LT, respectively, indicating a increase in LT for AH from 2014 to 2018. Yearly registrants from 2014 to 2018 were 32, 47, 51, 70, and 140, and recipients were 16, 24, 24, 38, and 88, respectively, indicating increases of 338% and 450% in registrants and recipients, respectively, since 2014. AH patients had the highest 1- and 3-year posttransplant survival (93.2% and 87.3%, respectively) and graft survival (90.4% and 84.8%, respectively) comparing to other LT recipients.

Conclusions: LT for AH in the United States is at an all-time high with an increased overall patient and graft survival.

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Conflict of interest statement

M.N. has been on the advisory board for Gilead, Intercept, Pfizer, Novartis, Blade, EchoSens North America, OWL, and Abbott. M.N. has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Novartis, Shire, and Zydus. M.N. is a minor shareholder or has stocks in Anaetos and Viking. N.A. has received research support from Genfit, Galmed, Madrigal, Allergan, and Gilead. N.A. has been on the advisory board for Gilead and Allergan. N.A. is on the speaker bureau for Intercept and Gilead.

Figures

FIGURE 1.
FIGURE 1.
Alcoholic hepatitis liver recipients by year illustrating the increase trend of AH for LT between 2004 and 2018. AH, alcoholic hepatitis; LT, liver transplantation.
FIGURE 2.
FIGURE 2.
Overall, 1- and 3-year patient survival: (A) overall patient 1-year survival (between 2004 and 2017) divided by most common etiologies including AH, ALD, HCC + ALD, HCC + HCV, HCC + NASH, HCV, HCV/ALD, NASH; (B) overall 3-year survival (between 2004 and 2015) for the same causes. AH, alcoholic hepatitis; ALD, alcoholic liver disease; CI, confidence intervals; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.
FIGURE 3.
FIGURE 3.
1- and 3-year graft survival: (A) 1-year graft survival (between 2004 and 2017) divided by most common etiologies including AH, ALD, HCC + ALD, HCC + HCV, HCC + NASH, HCV, HCV/ALD, NASH; (B) 3-year graft survival (between 2004 and 2015) for the same pathogenesis. AH, alcoholic hepatitis; ALD, alcoholic liver disease; CI, confidence intervals; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.
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