Division of Gastrointestinal and Liver Disease, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
Hepatol Commun. 2024 Jul 5;8(7). doi: 10.1097/HC9.0000000000000455. eCollection 2024 Jul 1.
Liver transplantation (LT) for alcohol-associated liver disease (ALD) is increasing and may impact LT outcomes for patients listed for HCC and other indications.
Using US adults listed for primary LT (grouped as ALD, HCC, and other) from October 8, 2015, to December 31, 2021, we examined the impact of center-level ALD LT volume (ATxV) on waitlist outcomes in 2 eras: Era 1 (6-month wait for HCC) and Era 2 (MMaT-3). The tertile distribution of ATxV (low to high) was derived from the listed candidates as Tertile 1 (T1): <28.4%, Tertile 2 (T2): 28.4%-37.6%, and Tertile 3 (T3): >37.6% ALD LTs per year. Cumulative incidence of waitlist death and LT within 18 months from listing by LT indication were compared using the Gray test, stratified on eras and ATxV tertiles. Multivariable competing risk regression estimated the adjusted subhazard ratios (sHRs) for the risk of waitlist mortality and LT with interaction effects of ATxV by LT indication (interaction p).
Of 56,596 candidates listed, the cumulative waitlist mortality for those with HCC and other was higher and their LT probability was lower in high (T3) ATxV centers, compared to low (T1) ATxV centers in Era 2. However, compared to ALD (sHR: 0.92 [0.66-1.26]), the adjusted waitlist mortality for HCC (sHR: 1.15 [0.96-1.38], interaction p = 0.22) and other (sHR: 1.13 [0.87-1.46], interaction p = 0.16) were no different suggesting no differential impact of ATxV on the waitlist mortality. The adjusted LT probability for HCC (sHR: 0.89 [0.72-1.11], interaction p = 0.08) did not differ by AtxV while it was lower for other (sHR: 0.82 [0.67-1.01], interaction p = 0.02) compared to ALD (sHR: 1.04 [0.80-1.34]) suggesting a differential impact of ATxV on LT probability.
The high volume of LT for ALD does not impact waitlist mortality for HCC and others but affects LT probability for other in the MMAT-3 era warranting continued monitoring.
由于与酒精相关的肝病（ALD）的肝移植（LT）不断增加，可能会影响接受 HCC 和其他适应证的 LT 的患者的 LT 结局。
使用美国 2015 年 10 月 8 日至 2021 年 12 月 31 日期间接受原发性 LT 的成年人（分为 ALD、HCC 和其他），我们研究了中心级 ALD LT 量（ATxV）对两个时期的候补名单结局的影响：时期 1（HCC 等待 6 个月）和时期 2（MMaT-3）。ATxV（低到高）的三分位数分布是从列出的候选人中得出的，分别为三分位数 1（T1）：<28.4%，三分位数 2（T2）：28.4%-37.6%，三分位数 3（T3）：>37.6%每年接受 ALD LT。使用 Gray 检验比较按 LT 适应证列出的候补名单死亡和 LT 的 18 个月内累积发生率，按时期和 ATxV 三分位数分层。多变量竞争风险回归估计了候补名单死亡率和 LT 的调整亚危险比（sHR），并考虑了 ATxV 与 LT 适应证之间的交互作用（交互 p）。
在 56596 名列入名单的候选人中，与低（T1）ATxV 中心相比，HCC 和其他适应证的候选人的候补名单死亡率更高，LT 概率更低。然而，与 ALD 相比（sHR：0.92 [0.66-1.26]），HCC（sHR：1.15 [0.96-1.38]，交互 p = 0.22）和其他（sHR：1.13 [0.87-1.46]，交互 p = 0.16）的调整候补名单死亡率没有差异，这表明 ATxV 对候补名单死亡率没有不同的影响。HCC（sHR：0.89 [0.72-1.11]，交互 p = 0.08）的 LT 概率没有差异，而其他（sHR：0.82 [0.67-1.01]，交互 p = 0.02）的 LT 概率低于 ALD（sHR：1.04 [0.80-1.34]），这表明 ATxV 对 LT 概率有不同的影响。
ALD 的 LT 高量不会影响 HCC 和其他适应证的候补名单死亡率，但会影响 MMAT-3 时期的其他适应证的 LT 概率，需要持续监测。
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