A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S.
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 f...
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Elsevier
2025-01-01
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| Series: | Gastro Hep Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S277257232400205X |
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| author | Shyam Patel Sohil Patel Wei Zhang Ashwani K. Singal Ramsey Cheung Robert J. Wong |
| author_facet | Shyam Patel Sohil Patel Wei Zhang Ashwani K. Singal Ramsey Cheung Robert J. Wong |
| author_sort | Shyam Patel |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-b2ce989370ef44219d03c422c9fb4e44 |
| institution | DOAJ |
| issn | 2772-5723 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Gastro Hep Advances |
| spelling | doaj-art-b2ce989370ef44219d03c422c9fb4e442025-08-20T02:55:53ZengElsevierGastro Hep Advances2772-57232025-01-014410060910.1016/j.gastha.2024.100609A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S.Shyam Patel0Sohil Patel1Wei Zhang2Ashwani K. Singal3Ramsey Cheung4Robert J. Wong5Department of Medicine, California Pacific Medical Center, San Francisco, CaliforniaSchool of Medicine, University of California, San Francisco, CaliforniaGastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MassachusettsDivision of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Transplant Hepatology, UofL Health Jewish Hospital and Trager Transplant Center, Rob Rexley VA Medical Center, Louisville, KentuckyDivision of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CaliforniaDivision of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Correspondence: Address correspondence to: Robert J. Wong, MD, MS, Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, California 94304.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.http://www.sciencedirect.com/science/article/pii/S277257232400205XMetabolic Dysfunction–Associated Steatotic Liver DiseaseMetabolic Dysfunction–Associated SteatohepatitisAlcohol-Associated Liver DiseaseUNOS |
| spellingShingle | Shyam Patel Sohil Patel Wei Zhang Ashwani K. Singal Ramsey Cheung Robert J. Wong A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. Gastro Hep Advances Metabolic Dysfunction–Associated Steatotic Liver Disease Metabolic Dysfunction–Associated Steatohepatitis Alcohol-Associated Liver Disease UNOS |
| title | A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. |
| title_full | A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. |
| title_fullStr | A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. |
| title_full_unstemmed | A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. |
| title_short | A Comprehensive Assessment of Liver Transplant Trends and Outcomes Among Adults With Steatotic Liver Disease in the U.S. |
| title_sort | comprehensive assessment of liver transplant trends and outcomes among adults with steatotic liver disease in the u s |
| topic | Metabolic Dysfunction–Associated Steatotic Liver Disease Metabolic Dysfunction–Associated Steatohepatitis Alcohol-Associated Liver Disease UNOS |
| url | http://www.sciencedirect.com/science/article/pii/S277257232400205X |
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