Alcohol-related liver disease accounts for 50% of liver-related deaths, and the rate is increasing worldwide. However, one of the best treatment options, early liver transplantation (ELT) (transplantation without mandatory abstinence period), remains the most controversial, due in part to concerns that patients may relapse to alcohol after transplantation. It’s also one of the things I’m brewing.
Part of the problem is that livers for transplantation are in short supply and researchers lack data to determine who would benefit most from ELT. Research shows that decisions about who receives a transplant can sometimes be influenced by bias and unsystematic influences. As a result, many patients do not receive life-saving treatment, and some patients’ health continues to deteriorate even after receiving a transplant.
“Significant knowledge gaps exist that lead to disparities in transplant access and post-transplant outcomes,” said Brian P. Lee, MD, assistant clinical professor of gastroenterology and liver disease at the Keck School of Medicine of the University of Southern California. said. “More data are urgently needed, as early transplantation for alcohol-related liver disease is now the fastest growing reason for liver transplantation.”
To this end, Lee and his collaborators have just received $12 million from the National Institutes of Health for seven years of research into ELT. Dr. Lee, co-principal investigator Nora Tellow, MD, professor of medicine and chief of the Division of Gastroenterology and Hepatology, and Neil Kaplowitz, MD, professor of liver disease at the Keck School of Medicine, and their collaborators, recruited participants from nine institutions across the United States. It is expected to be. to the country through the ACCELERATE consortium.
The team then collected audio recordings documenting how patients were selected for ELT, information on patient outcomes, and biological samples used to create a repository of data on alcohol and liver health. We collect a wide range of data, including: By the end of the funding period, researchers aim to understand how ELT can be offered equitably and effectively, based on patient characteristics and through a more systematic selection approach.
“Our goal is to stop the spread of alcohol-related liver disease and provide better treatment options to our patient community,” Lee said.
Overcoming health disparities
Decisions about who receives an organ transplant are not always fair. Research shows that factors such as race, socioeconomic status, and insurance type (public or private) influence both access to transplantation and health outcomes after surgery.
Lee and his colleagues are taking a closer look at the selection process to better understand where bias enters the equation. First, we compare the socio-economic status of patients based on their home address and transplant selection decisions. They also collect audio recordings during the transplant selection process to identify key factors that influence selection decisions. The insights gained can help develop best practices and checklists to reduce systemic bias. At the patient level, we analyze data on insurance type, income, and other social determinants of health.
Patients were drawn from nine sites across the country from a variety of demographic groups to ensure diversity in gender, age, race/ethnicity, education level, income level, and geographic region to reflect the full range of patients undergoing liver transplantation. Recruited in At the Keck School of Medicine, the majority of patients are Hispanic, Lee said, providing a unique opportunity to study how to best serve a group that has traditionally been underrepresented in medical research. Stated.
Building a biorepository
In addition to analyzing the selection process, researchers will collect data on what happens after selection, with the aim of improving transplant outcomes for patients. What factors predict alcohol relapse and what factors predict survival after transplantation? What are the most effective treatments to prevent and treat alcohol relapse? Patients with cardiovascular disease, cancer, or other Are you experiencing symptoms?
Patient surveys regarding quality of life, alcohol use, access to healthcare, and biological materials (radiology results, blood and microbiome samples, liver tissue and other data) will also be collected throughout the course of the study and will be placed in a shared biorepository. It will be saved. . With the patient’s permission, other scientists can use the samples for ELT and beyond research, including studies of alcohol-related hepatitis, alcohol use disorders, and liver health.
About this study
In addition to Lee and Theroux, collaborators on the project include Wendy Mack, Jennifer Dodge, Aaron Ahern and Myles Cockburn. Chanita Hughes Hulbert is a consultant.
This research was supported by the National Institutes of Health. [NIH R01AA030960].
