Long-Term Survival of Liver Transplantation in Alcohol-Associated Liver Disease: Insights From National Claims Data

AI Summary

Liver transplantation confers substantial survival benefit in ALD: eight-year mean survival 2600 versus 1799 days; adjusted mortality hazard ratio 0.365.
Significant sociodemographic disparities exist: female sex and African American race, older age, comorbidities, and metastatic cancer reduce transplantation odds.
Policy interventions and refined candidate selection are needed to ensure equitable access and optimise outcomes for patients with ALD.

TL;DR (AI Generated)

BACKGROUND: Alcohol-associated liver disease (ALD) is a leading indication for liver transplantation (LT) in the United States.

We used logistic regression to evaluate factors associated with LT, and Cox regression to compare survival between LT recipients and non-recipients.

Female sex (adjusted OR = 0.805; 95% Confidence Interval (CI): 0.750-0.866), African-American race (adjusted OR = 0.542; 95% CI: 0.462-0.636), older age, and non-liver comorbidities, and all types of metastatic cancer were associated with lower odds of LT; non-metastatic liver cancer, however, was associated with increased odds of LT (adjusted OR = 4.147; 95% CI: 3.659-4.699).

Basic summary

Alcohol Clin Exp Res (Hoboken). 2026 Nov;50(11):e70416. doi: 10.1111/acer.70416.

ABSTRACT

BACKGROUND: Alcohol-associated liver disease (ALD) is a leading indication for liver transplantation (LT) in the United States. While post-transplant outcomes are well established, the relative survival benefit of LT compared to non-LT remains underdefined.

METHODS: Using Optum’s de-identified Clinformatics Data Mart Database, we identified adults with ALD between 2017 and 2024. We used logistic regression to evaluate factors associated with LT, and Cox regression to compare survival between LT recipients and non-recipients.

RESULTS: Among 373,025 patients with ALD, 3453 underwent LT. Female sex (adjusted OR = 0.805; 95% Confidence Interval (CI): 0.750-0.866), African-American race (adjusted OR = 0.542; 95% CI: 0.462-0.636), older age, and non-liver comorbidities, and all types of metastatic cancer were associated with lower odds of LT; non-metastatic liver cancer, however, was associated with increased odds of LT (adjusted OR = 4.147; 95% CI: 3.659-4.699). The 8-year restricted mean survival time was 2600 days (~7.12 years) for LT recipients and 1799 days (~4.93 years) for nonrecipients. The median survival among deceased patients was 1000 days with LT vs. 355 days without LT. LT was associated with a lower adjusted mortality risk (HR, 0.365; 95% CI: 0.333-0.401).

CONCLUSION: LT confers a substantial survival advantage for patients with ALD, beyond what is achieved without transplantation. However, significant sex and race-based disparities persist, underscoring the need for policy interventions to promote equitable access and optimized candidate selection.

PMID:43002120 | DOI:10.1111/acer.70416

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