Researchers have recently tried to answer the question of why more people with alcohol-related liver disease are having transplants than in previous years.
Doctors have noticed a trend over the past 15 years of more people having transplants for alcohol-related liver disease. This begs the questions as to why. Are there more alcoholics? Is it related to the finding that more women are drinking dangerous amounts than before? Or is there another reason? This information is important for doctors to know, because, as with so many diseases, prevention is key. To determine how to prevent a disease, the reasons for it occurring need to be understood.
A team of researchers from the USA looked at data gathered by the United Network for Organ Sharing, between the years 2002-2016. They looked at the reason why the patient was having a liver transplant, and what the long-term survival was for patients who were having a transplant as a result of alcohol-related liver disease. Their findings were published in JAMA Internal Medicine.
Patients were more frequently Caucasian males
In total, the medical records of over 30,000 patients were reviewed. The proportion of liver transplants for alcohol-related liver disease increased from 24.2% in 2002 to 36.7% in 2016. Patients were more frequently male and Caucasian. They also noticed that the number of patients having a liver transplant for hepatitis C infections had decreased due to improvements in medical therapy for these patients. This decrease is partly responsible for the seeming increase in alcohol-related liver transplants.
Liver transplants became more accessible
Another major factor that the researchers identified for the increase was a change in policy that occurred regarding which patients could have a transplant for alcohol-related liver disease. Previously, only patients who had abstained from alcohol for six months could have a transplant. This approach changed, however, and without the period of abstinence is required, a liver transplant was more accessible for many patients than ever before. The increase in liver transplants was however different in different geographical areas across the USA. The researchers discuss that this may be due to different policies in place regarding the period of abstinence.
Survival greater than three months following the transplant was not as good for patients who had alcohol-related liver disease compared to other liver diseases. The researchers recommend further research to determine the causes of this. They also recommend a national policy be put into place for liver transplants for patients with alcohol-related liver disease to address the geographical differences for accessibility for this treatment.
Written by Nicola Cribb, VetMB DVSc Dip.ACVS
Reference: Lee B, Vittinghoff E, Dodge J, Cullaro G, Terrault N. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. Jama Intern Med. 2019;179(3). doi:10.1001/jamainternmed.2018.6536.
