Association of COVID-19 With New Waiting List Registrations and Liver Transplantation for Alcoholic Hepatitis in the United States

Abstract

Alcohol consumption has substantially increased during the COVID-19 pandemic 1 ; however, the impact on the already increasing burden of alcohol-associated liver disease (ALD) is unknown. 2 We examined national changes in waiting list registration and liver transplantation for ALD and the association with alcohol sales during the COVID-19 pandemic. We hypothesized that waiting list registrations and deceased donor liver transplants (DDLTs) for alcoholic hepatitis (AH), which can develop after a short period of alcohol misuse, would disproportionately rise. MethodsThis cross-sectional study was deemed exempt from review and informed consent by the University of Michigan institutional review board because the study involves deidentified, publicly available secondary data sets that cannot be tracked back to an individual. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for reporting cross-sectional studies. Data were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research file for new waiting list registrations and primary DDLT for US adults (age Ն18 years) between January 1, 2016, and January 31, 2021, and categorized by primary listing diagnosis as AH, alcohol-related cirrhosis (AC), or non-ALD (any other diagnosis). For each diagnosis, we characterized short-term changes during COVID-19 (March 2020 to January 2021) by comparing proportions of waiting list registrations and DDLTs to the same time frame pre-COVID-19 (March 2019 to January 2020) using χ 2 tests. To evaluate changes during COVID-19 compared with long-term trends, we compared observed monthly volumes of waiting list registrations and DDLTs from March 2020 to January 2021 with forecasted values based on pre-COVID-19 trends estimated from nonseasonal autoregressive integrated moving average models with first order differencing fit to monthly waiting list registrations and DDLTs for 4 years pre-COVID-19 (January 2016 to February 2020). 3 National monthly retail alcohol sales from January 2016 to January 2021 for purchases from beer, wine, and liquor stores in US dollars were obtained from the US Census Bureau Monthly Retail Trade Report. 4 The associations of alcohol sales, waiting list registrations, and DDLT were evaluated using Spearman rank-order correlation with a significance level of .05. Analyses were performed using Stata/SE version 16.0 (StataCorp). Data were analyzed from March to April 2021.

Covid-19 and alcohol associated liver disease

“…Transplants for severe AH increased by more than 50% during the COVID era and the median MELD-Na at listing and transplant also increased [43 , 44] . The increases in waiting list registrations and deceased donor liver transplantation for AH surpassed previously forecasted trends (pre-COVID 19 by more than 50%), whereas trends for non-ALD transplants remained more stable [45] . Although some of these changes reflect a changing landscape in LT for AH/ALD [46] , epidemiological data on disease burden, hospitalizations, and mortality suggest changing criteria isn't the only underlying factor behind this trend.…”

“… ALD Treatment and Liver Transplantation Anderson et al. (2021) [45] Liver Transplantation for AH Retrospective cohort study Adults registered in the UNOS database From June 2020 to January 2021, wait-list registrations for AH increased by 60% and transplants for AH increased by 62%. Bittermann et al.…”

How COVID-19 Affects Lung Transplantation: A Comprehensive Review

“…Though COVID-19-associated mortality among SOT recipients kept rising, a substantial reduction in transplantation procedures was reported throughout various countries [ 9 ]. As expected, this phenomenon led to an increase of people on waiting lists, with ensuing consequences [ 10 , 11 , 12 ].…”

CAQ Corner: Psychosocial and ethical considerations in patient selection for liver transplantation

“…[ 25 ] Other largely retrospective studies show that survival rates of patients with AAH in early LT are comparable to those performed for other indications. [ 26 ] LT in AAH has increased in recent years and during coronavirus disease 2019 (COVID‐19) pandemic [ 27 ] driven by trends of increasing societal alcohol consumption.…”