Recent trends in liver transplantation for alcoholic liver disease in the United States

Table 1 Recipient characteristics by etiology of liver disease

	HCV21707 (29.2%)	HCC16627 (22.4%)	ALD9400 (12.7%)	NASH4745 (6.4%)	P value
Age	54.1 ± 7.19	57.9 ± 7.8	53.5 ± 9.02	56.7 ± 10.2	< 0.001
Female	5799 (26.7%)	3928 (23.6%)	2210 (23.5%)	2237 (47.1%)	< 0.001
Race					< 0.001
White	15408 (71.0%)	11133 (67.0%)	7533 (80.1%)	4006 (84.4%)
Hispanic	3071 (14.2%)	2496 (15.0%)	1285 (13.7%)	524 (11%)
Black	2504 (11.5%)	1542 (9.3%)	371 (4.0%)	95 (2%)
Other	724 (3.3%)	1456 (8.8%)	211 (2.2%)	120 (2.5%)
BMI	28.4 ± 5.3	28.3 ± 5.3	27.9 ± 5.41	32 ± 6.1	< 0.001
Diabetes					< 0.001
None	16912 (77.9%)	11741 (70.6%)	7440 (79.2%)	2139 (45.1%)
Any	4430 (20.4%)	4733 (28.5%)	1828 (19.5%)	2545 (53.6%)
Unknown	365 (1.7%)	153 (0.9%)	132 (1.4%)	61 (1.3%)
MELD at transplant	22 ± 10	15 ± 8.3	25.1 ± 9.6	23.8 ± 9.2	< 0.001
HCC in explant	3919 (18.1%)	11034 (66.4%)	482 (5.1%)	260 (5.5%)	< 0.001

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; ALD: Alcoholic liver disease; NASH: Non-alcoholic steatohepatitis; BMI: Body mass index.

Table 2 Temporal trends in characteristics of alcoholic liver disease liver transplant recipients

	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	P value
n (% annual)	553 (12.8%)	597 (12.8%)	628 (12.4%)	688 (13.0%)	695 (12.7%)	660 (12.3%)	578 (11.1%)	608 (11.6%)	619 (11.7%)	651 (12.1%)	613 (11.4%)	685 (12.4%)	805 (13.9%)	1020 (16.5%)
Age	53.0 ± 8.2	52.9 ± 8.5	54.0 ± 8.8	53.4 ± 8.6	53.7 ± 8.6	54.5 ± 8.7	53.6 ± 8.9	54.3 ± 8.5	54.1 ± 8.9	54.0 ± 8.9	53.6 ± 8.9	52.8 ± 9.4	53.7 ± 9.7	52.5 ± 10.2	0.1
Female	124 (22.4%)	126 (21.1%)	125 (19.9%)	134 (19.5%)	156 (22.4%)	133 (20.2%)	127 (22.0%)	146 (24.0%)	164 (26.5%)	170 (26.1%)	153 (25.0%)	172 (25.1%)	200 (24.8%)	280 (27.5%)	0.001
Race															0.03
Black	15 (2.7%)	16 (2.7%)	23 (3.7%)	24 (3.5%)	32 (4.6%)	19 (2.9%)	21 (3.6%)	22 (3.6%)	18 (2.9%)	37 (5.7%)	23 (3.8%)	35 (5.1%)	38 (4.7%)	48 (4.7%)
Hispanic	71 (12.8%)	76 (12.7%)	76 (12.1%)	77 (11.2%)	98 (14.1%)	98 (14.8%)	95 (16.4%)	79 (13.0%)	85 (13.7%)	88 (13.5%)	93 (15.2%)	96 (14.0%)	103 (12.8%)	150 (14.7%)
Other	6 (1.1%)	12 (2.0%)	13 (2.1%)	12 (1.7%)	9 (1.3%)	12 (1.8%)	16 (2.8%)	9 (1.5%)	20 (3.2%)	16 (2.5%)	13 (2.1%)	18 (2.6%)	17 (2.1%)	38 (3.7%)
White	461 (83.4%)	493 (82.6%)	516 (82.2%)	575 (83.6%)	556 (80.0%)	531 (80.5%)	446 (77.2%)	498 (81.9%)	496 (80.1%)	510 (78.3%)	484 (79.0%)	536 (78.2%)	647 (80.4%)	784 (76.9%)
BMI	27.7 ± 5.3	27.8 ± 5.2	27.7 ± 5.5	27.9 ± 5.4	27.7 ± 5.4	28.4 ± 5.5	27.9 ± 5.4	27.9 ± 5.4	28.0 ± 5.6	27.9 ± 5.5	28.1 ± 5.4	28.0 ± 5.3	27.8 ± 5.4	28.0 ± 5.5	0.3
Diabetes															< 0.001
None	433 (78.3%)	458 (76.7%)	493 (78.5%)	538 (78.2%)	548 (78.8%)	484 (73.3%)	440 (76.1%)	485 (79.8%)	487 (78.7%)	518 (79.6%)	509 (83.0%)	560 (81.8%)	659 (81.9%)	828 (81.2%)
Any	103 (18.6%)	122 (20.4%)	116 (18.5%)	138 (20.1%)	134 (19.3%)	167 (25.3%)	131 (22.7%)	109 (17.9%)	127 (20.5%)	128 (19.7%)	100 (16.3%)	122 (17.8%)	144 (17.9%)	187 (18.3%)
Unknown	17 (3.1%)	17 (2.8%)	19 (3.0%)	12 (1.7%)	13 (1.9%)	9 (1.4%)	7 (1.2%)	14 (2.3%)	5 (0.8%)	5 (0.8%)	4 (0.7%)	3 (0.4%)	2 (0.2%)	5 (0.5%)
MELD	20.6 ± 8.4	21.6 ± 9.2	22.6 ± 9.5	22.6 ± 8.7	22.8 ± 8.5	23.9 ± 8.9	24.8 ± 9.0	25.1 ± 8.7	25.8 ± 9.4	26.1 ± 9.5	27.0 ± 9.3	27.5 ± 9.7	28.1 ± 9.6	28.9 ± 10.4	< 0.001
HCC in explant	58 (10.5%)	41 (6.9%)	51 (8.1%)	37 (5.4%)	44 (6.3%)	39 (5.9%)	30 (5.2%)	23 (3.8%)	18 (2.9%)	27 (4.1%)	24 (3.9%)	28 (4.1%)	23 (2.9%)	39 (3.8%)	< 0.001

BMI: Body mass index; HCC: Hepatocellular carcinoma.

Table 3 Changes in number of transplants per year for alcoholic liver disease by age group, gender and etiology

	Mean per year 2002-2012	Mean per year 2013-2015	Difference	Change	P value
Total	626.4	836.7	210.3	1.34	0.002
Age group (yr)
18-30	4.3	14.3	10.1	3.35	0.003
31-40	40.7	84.0	43.3	2.06	0.001
41-50	170.5	219.7	49.1	1.29	0.005
51-60	264.5	314.3	49.8	1.19	0.040
61-70	138.4	195.0	56.6	1.41	0.010
71-83	7.9	9.3	1.4	1.18	0.500
Gender
Female	141.6	217.3	75.7	1.53	0.001
Male	484.7	619.3	134.6	1.28	0.005
Etiology
Alcoholic cirrhosis	619.5	827.0	207.5	1.33	0.002
Alcoholic hepatitis	6.8	9.7	2.8	1.42	0.580
HCV/ALD	274.4	183.7	-90.7	0.67	0.050

HCV: Hepatitis C virus; ALD: Alcoholic liver disease.

Table 4 Changes in number of transplants per year for alcoholic liver disease by UNOS region

UNOS region	Mean per year 2002-2012	Mean per year 2013-2015	Difference	Change	P value
1	28.5	37.3	8.8	1.31	0.09
2	86.0	120.3	34.3	1.40	0.01
3	103.4	142.7	39.3	1.38	0.02
4	54.1	75.7	21.6	1.40	0.05
5	75.5	117.3	41.8	1.55	0.003
6	13.0	24.7	11.7	1.90	0.001
7	83.1	89.0	5.9	1.07	0.32
8	33.6	52.3	18.7	1.56	0.002
9	43.4	28.3	-15.0	0.65	0.23
10	52.3	71.0	18.7	1.36	0.03
11	53.5	78.0	24.5	1.46	0.005