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DALLAS – March 12, 2024 – Researchers at UT Southwestern Medical Center say the risk of dying while waiting for a liver transplant, or if the transplant fails, for patients with alcohol-related liver disease is significantly higher than that in humans. It is higher among racial and ethnic minorities. The survey results are transplantcould lead to targeted interventions that improve outcomes for high-risk groups suffering from alcohol-related hepatitis and cirrhosis.
Thomas Cotter, MD, assistant professor of internal medicine, is a member of the Division of Gastrointestinal and Liver Diseases at UT Southwestern.
“Our study looked at factors within individual patient populations and identified predictors of mortality or graft failure. Our goal is to reduce disparities in liver transplant outcomes. It's about pinpointing the area.” Thomas Cotter, MD,Assistant professor Internal medicine with members of Department of Gastrointestinal and Liver Diseases at UT Southwestern.
Liver transplantation for alcohol-related liver disease has increased over the past decade. Alcohol-associated cirrhosis (AAC) currently accounts for 32.1% of waiting list cases and 31.5% of transplants. Alcohol-associated hepatitis (AAH) has shown the fastest growth, with waiting lists increasing sixfold and transplants increasing ninefold annually.
UTSW researchers surveyed adult patients waitlisted in the U.S. transplant database from 2015 to 2021. Previous research To clarify the relationship between disparities in liver transplantation and geographic factors. The analysis took into account pretransplant characteristics such as age, gender, race, ethnicity, education level, employment status, and time on the waiting list. Although this database does not include variables related to pretransplant abstinence, the researchers included a control for duration of abstinence within the context of a large national database. Posttransplant characteristics, such as length of hospital stay and comorbidities, were also examined to assess frequency of liver transplantation, waiting list mortality, and graft survival.
Researchers found that waitlist mortality rates for AAC varied, with American Indian and Alaska Native patients facing a 33% higher risk of death compared with non-Hispanic whites. Similar trends were observed among Asians (23%) and Hispanics (17%), but non-Hispanic black patients had only a 7% higher risk. The study also found that Hispanic people with diabetes were at higher risk of dying during the waiting period and of transplant failure. In the AAC group, younger age, male sex, higher body mass index, and higher job or college education tended to have lower mortality rates across all racial and ethnic minority groups.
Transplant survival outcomes for patients with AAC also varied by race and ethnicity. Non-Hispanic black and American Indian/Alaska natives had the lowest 5-year survival rates after transplantation, but Hispanic and Asian patients had similar rates compared to non-Hispanic white patients. demonstrated outcomes. Study authors said these disparities highlight the need for better group-specific quality of patient care.
“This research focuses on key demographic, biological, and social determinants of health that can be leveraged for targeted interventions to improve outcomes for racial and ethnic minority populations. ,” Dr. Cotter said.
Dr. Cotter said factors associated with this disparity may include limited transplant access and delays in referral for evaluation. To address these disparities, he calls for broadening the scope of transplant interventions by considering not only mental health and substance abuse treatment, but also immunosuppression, psychosocial issues, and rates of return to alcohol. Proposed.
The researchers observed no difference in outcomes for AAH, which the authors said was likely due to the limited sample size available compared to AAC.
UTSW researchers from the Department of Internal Medicine who contributed to this study are Professor Mack Mitchell, Professor William Lee, Professor Jacqueline O'Leary, and Dr. Amit Singal. Associate Professors Thomas Carr, MD, PhD, Arjumand Mufti, MD, and Lisa VanWagner, MD; Assistant Professors Sarah Lieber, MD, Nicole Rich, MD, and Jeremy Louisan, MD;Postdoctoral Fellow Ahmad Anuti, MD, and Resident Mausam Patel, MD surgery Parthia Baghefi, MD, head of the Department of Surgical Transplantation, Stephen Hanisch, MD, and Assistant Professor Madhukar Patel.
This study was funded by the National Institutes of Health (U01-AA-026975, R01-MD012565, R01-CA256977, K08-CA259236).Dr. Cotter and his work research group teeth This award is supported by the American Association for the Study of Liver Diseases Clinical, Translational, and Outcomes Research Award and the National Institute on Alcohol Abuse and Alcoholism Career Development Award (K Series).
About UT Southwestern Medical Center
UT Southwestern is one of the nation's leading academic medical centers, combining pioneering biomedical research with outstanding clinical care and education. The institution's faculty have won six Nobel Prizes, including 25 members of the National Academy of Sciences, 21 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute investigators. There is. Our more than 3,100 full-time faculty members are responsible for groundbreaking medical advances and are committed to rapidly translating science-driven research into new clinical treatments. Physicians at the University of Texas Southwestern provide care to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits annually in more than 80 specialties. I am.
