Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2017; 9(36): 1315-1321
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1315
Recent trends in liver transplantation for alcoholic liver disease in the United States
Catherine E Kling, James D Perkins, Robert L Carithers, Dennis M Donovan, Lena Sibulesky
Catherine E Kling, James D Perkins, Lena Sibulesky, Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, United States
Robert L Carithers, Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA 98195, United States
Dennis M Donovan, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United States
Author contributions: Kling CE, Perkins JD and Sibulesky L designed the research; Kling CE, Perkins JD, Carithers RL, Donovan DM and Sibulesky L performed the research; Kling CE and Perkins JD analyzed the data; Kling CE wrote the paper; Kling CE, Perkins JD, Carithers RL, Donovan DM and Sibulesky L critically revised the manuscript for important intellectual content.
Institutional review board statement: This study met expedited review criteria as approved by the University of Washington Institutional Review Board.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Data sharing statement: Statistical code and dataset available from the corresponding author at lensasi@uw.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lena Sibulesky, MD, Assistant Professor of Surgery, Division of Transplant Surgery, Department of Surgery, University of Washington, 1959 NE Pacific St., Box 356410, Seattle, WA 98195, United States. lensasi@uw.edu
Telephone: +1-206-5986878 Fax: +1-206-5984287
Received: August 24, 2017
Peer-review started: August 25, 2017
First decision: November 1, 2017
Revised: November 7, 2017
Accepted: December 4, 2017
Article in press: December 5, 2017
Published online: December 28, 2017
Abstract
AIM

To examine temporal changes in the indications for liver transplantation (LT) and characteristics of patients transplanted for alcoholic liver disease (ALD).

METHODS

We performed a retrospective cohort analysis of trends in the indication for LT using the United Network for Organ Sharing (UNOS) database between 2002 and 2015. Patients were grouped by etiology of the liver disease and characteristics were compared using χ2 and t-tests. Time series analysis was used identifying any year with a significant change in the number of transplants per year for ALD, and before and after eras were modeled using a general linear model. Subgroup analysis of recipients with ALD was performed by age group, gender, UNOS region and etiology (alcoholic cirrhosis, alcoholic hepatitis and hepatitis C - alcoholic cirrhosis dual listing).

RESULTS

Of 74216 liver transplant recipients, ALD (n = 9400, 12.7%) was the third leading indication for transplant after hepatitis C and hepatocellular carcinoma. Transplants for ALD, increased from 12.8% (553) in 2002 to 16.5% (1020) in 2015. Time series analysis indicated a significant increase in the number of transplants per year for ALD in 2013 (P = 0.03). There were a stable number of transplants per year between 2002 and 2012 (linear coefficient 3, 95%CI: -4.6, 11.2) an increase of 177 per year between 2013 and 2015 (95%CI: 119, 234). This increase was significant for all age groups except those 71-83 years old, was observed for both genders, and was incompletely explained by a decrease in transplants for hepatitis C and ALD dual listing. All UNOS regions except region 9 saw an increase in the mean number of transplants per year when comparing eras, and this increase was significant in regions 2, 3, 4, 5, 6, 8, 10 and 11.

CONCLUSION

There has been a dramatic increase in the number of transplants for ALD starting in 2013.

Keywords: Alcoholic liver disease, Liver transplantation, Cirrhosis, Epidemiology, Hepatitis C

Core tip: Although the number of liver transplants done for alcoholic liver disease (ALD) has been stable been 2002 and 2012, since 2013 there has been a significant increase. This increase is seen across all age groups, although the proportional increases are higher for younger patients than older ones. The increase corresponds, but is incompletely explained, by a decrease in transplants for hepatitis C - ALD dual listing. The increase was also seen in most, but not all UNOS regions.