Concurrent Liver Diseases See Increase Among Adult Liver Transplant Recipients

Jess Howell, MBBS, PhD, MSc

New findings suggest concurrent liver diseases are increasing among adult liver transplant recipients in Australia and New Zealand, but do not seem to affect posttransplant survival.

The data additionally suggest these increases were predominantly driven by an increase in metabolic-associated fatty liver disease and alcohol-related liver disease.

“Capturing and reporting data for all liver disease causes in addition to primary liver disease cause in liver transplant registries will provide more accurate estimates of liver disease prevalence among transplant recipients than documenting primary liver disease alone,” wrote study author Jess Howell, MBBS, PhD, MSc, Department of Gastroenterology, St Vincent’s Hospital Melbourne.

The rising prevalence and significant morbidity of chronic liver diseases and related hepatocellular carcinoma (HCC) have made it a global threat. Liver transplantation remains the only curative option for those with advanced disease.

Investigators noted the relative contribution of individual liver diseases and liver disease cofactors to national liver transplantation rates help to reflect underlying community community prevalence of advanced chronic liver disease and HCC causes and the overall impact of national strategies in preventing disease.

The current retrospective, longitudinal registry study reported the difference in the number and proportion of adult liver transplants performed for different liver disease causes, while additionally determining trends in the number and proportion of liver transplants performed for concurrent liver diseases over time. The team further investigated the impact of concurrent liver diseases on posttransplant survival.

The study included adult liver transplants between January 1985 - December 2019 from the Australian and New Zealand Liver and Intestinal Transplant Registry. For each transplant, up to 4 liver disease causes were recorded, with concurrent liver diseases defined as >1 liver disease indication for transplantation, excluding hepatocellular carcinoma.

A total of 840 (15%) of 5101 adult liver transplant recipients were observed to have concurrent liver disease. The data show recipients with concurrent liver diseases were more likely to be male (78% versus 64%) and older (mean age 52 years versus 50 years).

Moreover, investigators identified a higher proportion of liver transplants for hepatitis B (12% versus 6%), hepatitis C (33% versus 20%), alcohol liver disease (23% versus 13%), and metabolic-associated fatty liver disease (11% versus 8%; all P <.001) when all indications were included, rather than primary diagnosis only.

Further, data show the number and proportion of liver transplants performed for concurrent liver diseases have increased from 8 (6%) during Era 1 of study (1985 - 1989) to 302 (20%) during Era 7 (2015 - 2019; P <.001).

Howell and colleagues noted that the data show concurrent liver diseases were not associated with increased post transplant mortality (adjusted hazard ratio, 0.98; 95% confidence interval [CI], 0.84 - 1.14).

“Our data support the proposal to capture all liver disease diagnoses that are listed as indications in liver transplantation registry databases,” Howell concluded.

The study, “The Hidden Epidemic: The Prevalence and Impact of Concurrent Liver Diseases in Patients Undergoing Liver Transplantation in Australia and New Zealand,” was published in Transplantation Direct.