A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S.

Gastro hep advances Pub Date : 2025-01-01 DOI:10.1016/j.gastha.2024.100609

Shyam Patel , Sohil Patel , Wei Zhang , Ashwani K. Singal , Ramsey Cheung , Robert J. Wong

{"title":"A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S.","authors":"Shyam Patel , Sohil Patel , Wei Zhang , Ashwani K. Singal , Ramsey Cheung , Robert J. Wong","doi":"10.1016/j.gastha.2024.100609","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Steatotic liver disease (SLD) is the leading indication for liver transplantation (LT) among U.S. adults. We aim to provide comprehensive updates of LT trends and outcomes among adults with SLD, highlighting racial, ethnic, and sociodemographic disparities.</div></div><div><h3>Methods</h3><div>Using data from the 2010 to 2023 United Network for Organ Sharing registry, we performed a retrospective cohort study evaluating LT waitlist trends, waitlist outcomes, and post-LT survival among 65,675 adults with SLD. Disparities in LT outcomes were evaluated using adjusted competing risks analyses.</div></div><div><h3>Results</h3><div>From 2014 to 2023, there was an increasing proportion of Hispanics, women, and younger adults with SLD listed for LT. For Hispanics, this was driven by metabolic dysfunction–associated steatohepatitis (MASH); 19.9% of MASH wait-listings in 2023 were Hispanics. For women and younger adults (18–39 years), this was driven by alcohol-associated liver disease (ALD); 30.9% and 16.4% of ALD-related wait-listings in 2023 were women and younger adults, respectively. Women (vs men) had greater waitlist removal risk (subdistribution hazard ratio (sHR) 1.12, 95% confidence interval (CI) 1.07–1.18) and lower likelihood of LT receipt (sHR 0.87, 95% CI, 0.85–0.90). Ethnic minorities had worse outcomes, particularly Hispanics, who had a 37% higher risk of waitlist removal (sHR 1.37, 95% CI, 1.30–1.45) and 16% lower likelihood of LT receipt (sHR 0.86, 95% CI, 0.82–0.87) vs non-Hispanic whites. Disparities in post-LT survival were also observed.</div></div><div><h3>Conclusion</h3><div>In 2023, nearly one-quarter of MASH liver transplant waitlist registrants were Hispanics. Approximately half and 1 in 6 ALD waitlist registrants were women and younger adults, respectively. These concerning trends are amplified by the disparities in LT outcomes observed among women and ethnic minorities.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 4","pages":"Article 100609"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastro hep advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S277257232400205X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Steatotic liver disease (SLD) is the leading indication for liver transplantation (LT) among U.S. adults. We aim to provide comprehensive updates of LT trends and outcomes among adults with SLD, highlighting racial, ethnic, and sociodemographic disparities.

Methods

Using data from the 2010 to 2023 United Network for Organ Sharing registry, we performed a retrospective cohort study evaluating LT waitlist trends, waitlist outcomes, and post-LT survival among 65,675 adults with SLD. Disparities in LT outcomes were evaluated using adjusted competing risks analyses.

Results

From 2014 to 2023, there was an increasing proportion of Hispanics, women, and younger adults with SLD listed for LT. For Hispanics, this was driven by metabolic dysfunction–associated steatohepatitis (MASH); 19.9% of MASH wait-listings in 2023 were Hispanics. For women and younger adults (18–39 years), this was driven by alcohol-associated liver disease (ALD); 30.9% and 16.4% of ALD-related wait-listings in 2023 were women and younger adults, respectively. Women (vs men) had greater waitlist removal risk (subdistribution hazard ratio (sHR) 1.12, 95% confidence interval (CI) 1.07–1.18) and lower likelihood of LT receipt (sHR 0.87, 95% CI, 0.85–0.90). Ethnic minorities had worse outcomes, particularly Hispanics, who had a 37% higher risk of waitlist removal (sHR 1.37, 95% CI, 1.30–1.45) and 16% lower likelihood of LT receipt (sHR 0.86, 95% CI, 0.82–0.87) vs non-Hispanic whites. Disparities in post-LT survival were also observed.

Conclusion

In 2023, nearly one-quarter of MASH liver transplant waitlist registrants were Hispanics. Approximately half and 1 in 6 ALD waitlist registrants were women and younger adults, respectively. These concerning trends are amplified by the disparities in LT outcomes observed among women and ethnic minorities.

查看原文本刊更多论文

美国成人脂肪变性肝病患者肝移植趋势和结果的综合评估

背景和目的脂肪变性肝病（SLD）是美国成人肝移植（LT）的主要适应症。我们的目标是提供全面更新的成人SLD患者的LT趋势和结果，突出种族、民族和社会人口差异。方法：使用2010年至2023年联合器官共享网络登记处的数据，我们进行了一项回顾性队列研究，评估了65,675名成人SLD患者的LT等待名单趋势、等待名单结果和LT后生存率。使用调整后的竞争风险分析评估肝移植结果的差异。从2014年到2023年，患有SLD的西班牙裔、女性和年轻人被列为lt的比例不断增加。对于西班牙裔来说，这是由代谢功能障碍相关脂肪性肝炎（MASH）驱动的；2023年，19.9%的待售房屋是西班牙裔。对于女性和年轻人（18-39岁），这是由酒精相关肝病（ALD）驱动的；2023年，与老年痴呆症相关的待售房源中，女性和年轻人分别占30.9%和16.4%。女性（与男性相比）有更大的等待名单移除风险（亚分布风险比（sHR） 1.12, 95%置信区间（CI） 1.07-1.18）和更低的接受LT的可能性（sHR 0.87, 95% CI, 0.85-0.90）。少数族裔的预后较差，特别是西班牙裔，与非西班牙裔白人相比，他们被移除候补名单的风险高出37% (sHR 1.37, 95% CI, 1.30-1.45)，接受LT的可能性低16% （sHR 0.86, 95% CI, 0.82-0.87）。肝移植后生存的差异也被观察到。2023年，近四分之一的MASH肝移植等候名单注册者是西班牙裔。大约一半和六分之一的ALD候补登记者分别是女性和年轻人。在妇女和少数民族中观察到的LT结果的差异放大了这些令人担忧的趋势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊