Racial and Ethnic Disparities in Liver Transplantation for Alcohol-associated Liver Diseases in the United States

Abstract

Background. Emerging data suggest disparities exist in liver transplantation (LT) for alcohol-associated liver disease (ALD). As the incidence of ALD increases, we aimed to characterize recent trends in ALD LT frequency and outcomes, including racial and ethnic disparities. Methods. Using United Network for Organ Sharing/Organ Procurement and Transplantation Network data (2015 through 2021), we evaluated LT frequency, waitlist mortality, and graft survival among US adults with ALD (alcohol-associated hepatitis [AH] and alcohol-associated cirrhosis [AAC]) stratified by race and ethnicity. We used adjusted competing-risk regression analysis to evaluate waitlist outcomes, Kaplan–Meier analysis to illustrate graft survival, and Cox proportional hazards modeling to identify factors associated with graft survival. Results. There were 1211 AH and 26 526 AAC new LT waitlist additions, with 970 AH and 15 522 AAC LTs performed. Compared with non-Hispanic White patients (NHWs) with AAC, higher hazards of waitlist death were observed for Hispanic (subdistribution hazard ratio [SHR] = 1.23, 95% confidence interval [CI]: 1.16-1.32), Asian (SHR = 1.22, 95% CI:1. 01-1.47), and American Indian/Alaskan Native (SHR = 1.42, 95% CI: 1.15-1.76) candidates. Similarly, significantly higher graft failures were observed in non-Hispanic Black (HR = 1.32, 95% CI: 1.09-1.61) and American Indian/Alaskan Native (HR = 1.65, 95% CI: 1.15-2.38) patients with AAC than NHWs. We did not observe differences in waitlist or post-LT outcomes by race or ethnicity in AH, although analyses were limited by small subgroups. Conclusions. Significant racial and ethnic disparities exist for ALD LT frequency and outcomes in the United States. Compared with NHWs, racial and ethnic minorities with AAC experience increased risk of waitlist mortality and graft failure. Efforts are needed to identify determinants for LT disparities in ALD that can inform intervention strategies.

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

“…Despite NHB patients showing lower inpatient mortality rates for AH, we noted a lower rate of liver transplants within this demographic. Our study supports previous ndings from various transplant databases (30)(31)(32) and underscores disparities rooted in multifaceted factors. Firstly, there is a noted variation in the severity of alcohol-related liver injury and recovery among racial groups, with NHB individuals potentially experiencing milder AH compared to NHW (26).…”

Racial and Ethnic Disparities in Liver Transplantation for Alcohol-associated Liver Diseases in the United States

“…Transplantation for Alcohol-associated Liver Diseases in the United States Khaled Elsokary, DO, 1 Sonia Samuel, DO, 1 Naoru Koizumi, PhD, 2 and Jorge Ortiz, MD 3 To the Editor, W e read the article entitled "Racial and Ethnic Disparities in Liver Transplantation for Alcoholassociated Liver Diseases in the United States" with great interest. 1 We congratulate the authors for this unique and successful review that identifies the determinants for liver transplant (LT) disparities in patients with alcohol-associated liver disease (ALD).…”

“…There was no difference in waitlist or post-LT outcomes by race or ethnicity in alcohol-associated hepatitis (AH) patients, limited by small subgroups. 1 To better understand the demographic impact on listing and survival outcomes among AH LT, we published a retrospective analysis entitled "Demographic inequities exist and influence transplant outcomes in liver transplantation for acute alcohol associated hepatitis." 2 We reviewed the available data using the United Network of Organ Sharing database from 2000 to 2021, specifically 25 981 LT recipients with AAC and 662 recipients with AH, to identify demographic and racial disparities in LT outcomes.…”

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

“…Women also develop cirrhosis with lower amounts of alcohol 19 . A recent study demonstrated that Hispanics, Asians and American Indian/Alaskan Natives had higher hazard ratios (HR) of waitlist deaths in alcohol‐associated cirrhosis when compared to non‐Hispanic Whites 20 . In the United States, young age, female gender and Hispanic race are independently associated with both the burden of ALD and the occurrence of ACLF 21 .…”