The growing burden of alcohol use disorders and alcohol-related liver disease
While previous studies have documented disparities in liver transplants overall, disparities in liver transplants for ALD are less clear, Dr. Rosenblatt says. Decisions about organ transplants for people with the disease are particularly difficult. Although alcohol use disorder is becoming more accepted as a chronic illness, the diagnosis still carries stigma.
“We wanted to look at factors that influence decisions about who gets on the waiting list, because we know that subjective bias can creep in there,” Dr. Rosenblatt says. “When you add another layer of potential subjectivity, bias can come to the surface. In the case of liver disease, that's the case with alcohol. ALD is the most subjective disease we deal with when determining transplant eligibility.”
Dr. Alison Kaplan
As ALD cases rise, questions about disparities become more urgent. “Alcohol-related liver disease is increasing exponentially in the United States,” said Dr. Alison Kaplan, MD“The majority of the cases that we evaluate for transplant are due to alcohol use, and that problem has been exacerbated by COVID, so this is really important for all of us in the healthcare profession,” said Dr. John F. Kennedy, an adult transplant hepatology fellow at NewYork-Presbyterian/Weill Cornell Medicine and lead author of the study.
Disparities have been found to affect the allocation of livers to vulnerable groups on waiting lists. Women with ALD are less likely to receive transplants, but they also have lower alcohol intake and are more susceptible to the disease, are less likely to receive treatment for alcohol use disorder, and have increasingly higher rates of alcohol use, the authors write. Black patients are most susceptible to ALD and have poorer post-transplant survival rates.
