Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1315
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
Processing time: 124 Days and 18 Hours
To examine temporal changes in the indications for liver transplantation (LT) and characteristics of patients transplanted for alcoholic liver disease (ALD).
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).
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.
There has been a dramatic increase in the number of transplants for ALD starting in 2013.
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.