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Presentation Number: Sa1462

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AuthorBlock: Dharmesh H Kaswala1, Sundaram Vinay2, Robert J. Wong3
1California Pacific Medical Center, San Francisco, California, United States; 2Cedars Sinai Medical Center, Los Angeles, California, United States; 3Alameda Health System-Highland Hospital, Oakland, California, United States;

Background: Alcoholic liver disease (ALD) is soon becoming the leading etiology of liver disease among adults on the liver transplantation (LT) waitlist in the U.S. Few studies have focused specifically on LT waitlist outcomes among ALD. Understanding trends and disparities in waitlist outcomes among ALD patients is especially important given the significant burden of ALD in the U.S.

Aim: To evaluate overall rates and predictors of waitlist mortality, probability of receiving LT, and post-LT survival among U.S. adults with ALD awaiting LT, with a focus on race/ethnicity-specific disparities.

Methods: We retrospectively evaluated U.S. adults with ALD listed for LT using data from the 2005-2016 United Network for Organ Sharing LT registry. Overall and stratified probability of LT waitlist mortality, receipt of LT, and post-LT survival among ALD patients were evaluated with Kaplan-Meier methods and multivariate Cox proportional hazards models. The final models adjusted for age, sex, race/ethnicity, presence of hepatocellular carcinoma, MELD score, presence of ascites or hepatic encephalopathy, and year of LT waitlist registration.

Results: Among 22,385 ALD listed for LT from 2005-2016 (75.6% male, 77.9% non-Hispanic white, 17.0% Hispanic, mean age 54.2 ± 9.0, 8.9% with HCC, mean MELD at listing was 19.8 ± 8.8), overall probability of 90-day waitlist survival was 59% (95% CI 57-60), 90-day probability of receiving LT was 32% (95% CI 31-33), and 5-year post-LT survival was 77% (95% CI 76-78). Compared to non-Hispanic whites with ALD, lower waitlist mortality was observed in African Americans (HR 0.74, 95% CI 0.57-0.95, p=0.02), whereas ALD patients with concurrent HCC had significantly higher waitlist mortality (HR 1.79, 95% CI 1.45-2.22, p<0.001). When evaluating probability of receiving LT, men with ALD had significantly greater probability of receiving LT compared to women (HR 1.19, 95% CI 1.13-1.25, p<0.001), whereas Hispanics had significantly lower probability of receiving LT compared to non-Hispanic whites (HR 0.74, 95% CI 0.70-0.79, p<0.001). ALD patients with HCC were more likely to receive LT compared to those without HCC (HR 2.32, 95% CI 2.16-2.50, p<0.001). When evaluating post-LT outcomes, African Americans with ALD had significantly higher risk of post-LT death compared to non-Hispanic whites (HR 1.29, 95% CI 1.04-1.60, p=0.01).

Conclusion: Among U.S. adults with ALD awaiting LT, significant race/ethnicity-specific disparities in LT outcomes were observed. While African Americans and Hispanics with ALD had lower risk of waitlist death, Hispanics were significantly less likely to receive LT and African Americans had significantly higher post-LT mortality.

Alcoholic Liver Disease patients racial distribution in liver transplant(LT) mortality, probability of receiving LT and post LT Mortality

 Multivariate Model of Waitlist MortalityMultivariate Model of Probability of Receiving LTMultivariate model of Post LT Mortality
Race/EthnicityHR95% CIP-ValueHR95% CIP-ValueHR95% CIP-Value
Non-Hispanic White1.00Reference-1.00Reference-1.00Reference-
African American0.740.57-0.950.020.980.88-1.090.781.291.04-1.60.016