Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Background and Aims:With the availability of direct-acting antiviral(DAA)therapy for hepatitis C virus(HCV)infection and changing liver disease etiology for liver transplantation(LT),data on the changes in LT recipient population in the DAA era are scanty.Methods:The United Network for Organ Sharing(UNOS)registry(01/2007 to 06/2018)was used to develop a retrospective cohort of LT recipients for HCV,alcohol-associated liver disease(ALD),and non-alcoholic steatohepatitis(NASH).LT recipients in the DAA era(2013-2018)were compared with those in the pre-DAA era(2007-2012)era for recipient characteristics.Chi-square and analysis of variance were the statistical tests used for categorical and continuous variables,respectively.Results:Of 40,309 LT recipients(21,110 HCV,7586 NASH,and 11,713 ALD),the 21,790 in the DAA era(9432 HCV,7240 ALD,and 5118 NASH)were more likely to be older,female,obese,diabetic,have acute-on-chronic liver failure with a higher model for end-stage liver disease score,receive grafts with a lower donor risk index,and have waited on the LT list for a shorter period compared with their pre-DAA era counterparts.Specific to ALD,LT recipients with alcohol hepatitis were more likely to be younger at the time of LT.Of 9895 LT recipients with hepatocellular carcinoma,recipients in the DAA era were observed to have a higher proportion of HCV(43%vs.32%,p<0.001),a lower proportion of ALD(9%vs.12%,p<0.001),and no change for NASH(13%vs.13%,p=0.9)compared with the pre-DAA era.Within the hepatocellular carcinoma population,LT recipients in the DAA era were older,diabetic,and waited on the LT list longer compared with their pre-DAA counterparts.Conclusions:Along with changing liver disease etiology in the DAA era,the LT recipient population demographics,comorbidities,liver disease severity,and graft quality are changing.These changes are relevant for future studies,immunosuppression,and post-transplant follow-up.

Racial and Health Disparities among Cirrhosis-related Hospitalizations in the USA

Background and Aims:Alcohol-associated liver disease(ALD)is the most common cause of advanced liver disease worldwide,including in the USA.Alcohol use and cirrhosis mortality is higher in American Indian/Alaska Native(AI/AN)compared to Whites.Data are scanty on ALD as a liver disease etiology in AI/AN compared to other races and ethnicities.Methods:The National Inpatient Sample on 199,748 cirrhosis-related hospitalizations,14,241(2,893 AI/AN,2,893 Whites,2,882 Blacks,2,879 Hispanics,and 2,694 Asians or other races)matched 1:1 for race/ethnicity on demographics,insurance,and income quartile of the residence zip code analyzed.Results:After controlling for geographic location and hospital type,odds ratio(OR)and 95%confidence interval(CI)for ALD as cirrhosis etiology was higher among admissions in AI/AN vs.Whites[1.55(1.37–1.75)],vs.Blacks[1.87(1.65–2.11)],vs.Hispanic[1.89(1.68–2.13)]and Asians/other races[2.24(1.98–2.53)].OR was also higher for AI/AN vs.all other races for alcohol-associated hepatitis(AH)as one of the discharge diagnoses.The findings were similar in a subgroup of 4,649 admissions with decompensated cirrhosis and in a cohort of 350 admissions with acute-on-chronic liver failure as defined by EASL-CLIF criteria.Alcohol use disorder diagnosis was present in 38%of admissions in AI/AN vs.24–30%in other races,p<0.001.A total of 838(5.9%)admissions were associated with in-hospital mortality.OR(95%CI)for in-hospital mortality in AI/AN individuals was 34%reduced vs.Blacks[0.66(0.51–0.84)],but no difference was observed on comparison with other races.Conclusions:ALD,including AH,is the most common etiology among cirrhosisrelated hospitalizations in the USA among AI/AN individuals.In-hospital mortality was observed in about 6%of admissions,which was higher for Blacks and similar in other races compared to admissions for AI/AN.Public health policies should be implemented to reduce the burden of advanced ALD among AI/AN individuals.

Sending an SOS: Healing the Liver with the Bone Marrow

Citation of this article:Ayares G,Arab JP,Singal AK.Sending an SOS:Healing the Liver with the Bone Marrow.J Clin Transl Hepatol 2022;10(1):1-3.doi:10.14218/JCTH.2021.00557.Cirrhosis,an end stage of any chronic liver disease is a form of impaired regeneration leading to progressive dif-fuse hepatic fibrosis.The healthcare burden of cirrhosis is increasing,and it is currently the 13th leading cause of death globally.The progression of liver injury and fibrosis results in portal hypertension and hepatic insufficiency.