Digestive diseases and sciences · 2026
Increasing Liver Transplant Listings for Alcohol-Associated Hepatitis in Younger Patients with High MELD Scores and Excellent Performance Status.
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Elfeki Mohamed A, Zhang Wanyu, Dunn Winston, Arab Juan Pablo, Kong Maiying, Singal Ashwani K
Аннотация
BACKGROUND AND AIM: This study examines patient traits linked to LT listings for AH.
METHODS AND RESULTS: 1325 of 41,558 ALD (3.2%) in US (2012-21) listed for AH vs. non-AH were younger (43 vs. 53 years), had higher BMI (29 vs. 28) and MELD (34 vs. 22). Factors associated with AH listing included black or other race, diabetes mellitus, excellent performance status, and higher MELD scores. Conversely, age < 50, Hispanic race, and lower education correlated with lower odds for AH listing. The proportion of AH listings increased from 1.1% (2002-2011) to 4.1% (2012-2021), with over twofold increase (OR 2.10, 95% CI: 1.69-2.61). Logistic regression models controlling baseline factors showed that the odds of AH listing in 2012-2021 vs. 2002-2011 were 5.27 for age ≤ 35, 4.76 for MELD ≥ 35, and 4.08 for excellent performance status. AH candidates had lower 90-day waitlist mortality (0.71, 95% CI: 0.60-0.83) and higher receipt of LT (1.49, 95% CI: 1.21-1.88). Among 16,190 LTs, the graft quality for AH and non-AH recipients was similar.
CONCLUSION: Listing for AH among ALD candidates is increasing in younger patients with high MELD scores and excellent functional status. Establishing standardized criteria for LT in AH patients is essential to optimize graft utilization.
METHODS AND RESULTS: 1325 of 41,558 ALD (3.2%) in US (2012-21) listed for AH vs. non-AH were younger (43 vs. 53 years), had higher BMI (29 vs. 28) and MELD (34 vs. 22). Factors associated with AH listing included black or other race, diabetes mellitus, excellent performance status, and higher MELD scores. Conversely, age < 50, Hispanic race, and lower education correlated with lower odds for AH listing. The proportion of AH listings increased from 1.1% (2002-2011) to 4.1% (2012-2021), with over twofold increase (OR 2.10, 95% CI: 1.69-2.61). Logistic regression models controlling baseline factors showed that the odds of AH listing in 2012-2021 vs. 2002-2011 were 5.27 for age ≤ 35, 4.76 for MELD ≥ 35, and 4.08 for excellent performance status. AH candidates had lower 90-day waitlist mortality (0.71, 95% CI: 0.60-0.83) and higher receipt of LT (1.49, 95% CI: 1.21-1.88). Among 16,190 LTs, the graft quality for AH and non-AH recipients was similar.
CONCLUSION: Listing for AH among ALD candidates is increasing in younger patients with high MELD scores and excellent functional status. Establishing standardized criteria for LT in AH patients is essential to optimize graft utilization.