Differential candidate characteristics associated with increasing ALD and MASH among liver transplant listings in the US

Abstract

Background and aim

Alcohol-associated liver disease (ALD) and metabolic associated steatohepatitis (MASH) are leading indications for liver transplant (LT). Data are limited on their trends and association with candidate characteristics.

Methods and Results

UNOS database (2002–22) examined on proportion of ALD or of NASH etiology among LT listings comparing 2002–11 vs. 2012–22. Of 169,385 listings, 41,558 (24.5 %) and 21,789 (12.9 %) listed for ALD and MASH respectively. Proportion of ALD increased 2 folds between 2002–11 and 2012–22. Stratified multivariable logistic regression models showed age <35 yrs., females, blacks and Asians, non-diabetics, education below high school, Medicaid insurance, and MELD > 35 with highest increase in ALD. Candidates listed with ALD vs. others had lower 90-d waitlist mortality, SHR 0.85 [0.83–0.87]. Although, AH as listing diagnosis only contributed to 3.2 % of ALD candidates, this subtype of ALD was associated with increasing ALD trends among candidates <35 yrs. of age, with college or higher education, and MELD ≥35. The proportion of MASH increased 3 folds between 2002–11 and 2012–22. Stratified models showed age 35–64 yrs., males, blacks and Asians, diabetics, college or above education, Medicare insurance, and MELD < 25 with highest increase in MASH. Candidates listed with MASH vs. others had similar 90-d waitlist mortality, SHR 0.99 [0.97–1.03].

Conclusions

MASH and ALD in LT listing increased, with differential increase based on candidate characteristics. These findings are relevant in organ allocation and designing public policies to control MASH and ALD.