Ochoa-Allemant Pedro, Serper Marina, Wang Roy X, Tang Helen, Ghandour Bachir, Khan Sarem, Mahmud Nadim
Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hepatology. 2025 Feb 1;81(2):532-545. doi: 10.1097/HEP.0000000000000914. Epub 2024 Apr 29.
The new steatotic liver disease (SLD) nomenclature introduced metabolic and alcohol-associated liver disease (MetALD), describing the intersection of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. Waitlisting and liver transplantation for MetALD are not well defined. We aimed to develop and validate an algorithm for identifying SLD phenotypes and assessing trends in waitlisting and transplant outcomes.
We conducted a retrospective cohort study using the United Network for Organ Sharing registry, supplemented with detailed single-center data. We developed 5 candidate algorithms for SLD classification and calculated their diagnostic performance. Trends in waitlist registrations and transplants were estimated, and competing risk analyses and Cox regression models were conducted to assess waitlist removal and posttransplant outcomes among SLD phenotypes. The best-performing algorithm demonstrated substantial agreement (weighted kappa, 0.62) for SLD phenotypes, with acceptable sensitivity (73%) for MetALD. Between 2002 and 2022, waitlist registrations and transplants for MetALD increased 2.9-fold and 3.3-fold, respectively. Since 2013, there has been a significant increase in the absolute number of waitlist registrations (122 per year; 95% CI, 111-133) and transplants (107 per year; 95% CI, 94-120) for MetALD. Patients with MetALD experienced higher waitlist removal (adjusted subdistribution hazard ratio, 1.10; 95% CI, 1.03-1.17), all-cause mortality (adjusted hazard ratio, 1.13; 95% CI, 1.03-1.23), and graft failure (adjusted hazard ratio, 1.12; 95% CI, 1.03-1.21) than those with alcohol-associated liver disease.
We developed and validated an algorithm for identifying SLD phenotypes in UNOS. MetALD is the third leading etiology among those waitlisted and underwent transplantation, exhibiting worse pretransplantation and posttransplantation outcomes compared to alcohol-associated liver disease. Identifying and addressing factors determining poor outcomes is crucial in this patient population.
新的脂肪性肝病（SLD）命名法引入了代谢性和酒精性肝病（MetALD），描述了代谢功能障碍相关脂肪性肝病与酒精性肝病的交集。MetALD的等待名单和肝移植情况尚无明确界定。我们旨在开发并验证一种算法，用于识别SLD表型并评估等待名单和移植结果的趋势。
我们使用器官共享联合网络登记处进行了一项回顾性队列研究，并补充了详细的单中心数据。我们开发了5种用于SLD分类的候选算法，并计算了它们的诊断性能。估计了等待名单登记和移植的趋势，并进行了竞争风险分析和Cox回归模型，以评估SLD表型中的等待名单移除情况和移植后结果。表现最佳的算法在SLD表型上显示出高度一致性（加权kappa值为0.62），对MetALD具有可接受的敏感性（73%）。2002年至2022年期间，MetALD的等待名单登记和移植分别增加了2.9倍和3.3倍。自2013年以来，MetALD的等待名单登记绝对数量（每年122例；95%置信区间，111 - 133）和移植绝对数量（每年107例；95%置信区间，94 - 120）显著增加。与酒精性肝病患者相比，MetALD患者的等待名单移除率更高（调整后的亚分布风险比为1.10；95%置信区间，1.03 - 1.17）、全因死亡率更高（调整后的风险比为1.13；95%置信区间，1.03 - 1.23）以及移植物失败率更高（调整后的风险比为1.12；95%置信区间，1.03 - 1.21）。
我们开发并验证了一种用于在器官共享联合网络中识别SLD表型的算法。MetALD是等待名单登记和接受移植患者中的第三大主要病因，与酒精性肝病相比，其移植前和移植后的结果更差。识别并解决决定不良结果的因素对这一患者群体至关重要。
