Alarming Surge in Alcohol-Related Liver Transplants in Younger Adults

Rates of alcohol-induced liver disease (AILD)-related hospitalizations and liver transplants surged over the past two decades, with particularly steep increases among younger adults in recent years, an analysis of U.S. data showed.

From 2005 to 2021, hospitalizations for AILD doubled from 63 to 129 per 100,000 women, while increasing from 187 to 302 per 100,000 men, reported Michele Molinari, MD, MSc, of UPMC Montefiore in Pittsburgh, and colleagues.

And over that time, rates of liver transplant related to AILD rose from 1.9 to 8.4 per million women and from 10.4 to 20.1 per million men (P<0.001 for all trends). Significant increases for hospitalizations and transplants were seen across sex and age groups, the team detailed in JAMA.

“Although older males had the highest absolute increases, the greatest relative increases occurred in younger individuals, particularly females,” wrote Molinari and co-authors. Hospitalizations among younger women increased by a relative 283% during the study period as liver transplants increased by 2,284%. Younger men had increases of 169% and 684%, respectively.

“These findings highlight an important need to elucidate the biopsychosocial factors driving alcohol use and formulate preventive strategies targeted to younger individuals, especially females,” the authors concluded.

Excessive alcohol use was responsible for 20% of the deaths in adults ages 20 to 49 in the years leading up to the pandemic, noted Molinari and colleagues. And by all accounts, the COVID pandemic has only made things worse. One study, for example, showed a 22% increase in deaths related to alcohol use disorder in 2021 compared with projected numbers.

Decompensated AILD is the top indication for liver transplant, but a lack of data exist on demographic factors associated with AILD and AILD-related transplant, according to the researchers, who sought to evaluate trends in recent years.

For their study, Molinari’s team used the National Inpatient Sample (NIS) to look at AILD-related hospitalizations and the Scientific Registry of Transplant Recipients for AILD-related liver transplants from 2005 to 2021. NIS data were weighted to calculate national estimates.

They found 6.5 million AILD-related hospitalizations during that time, 71% of which were in men; 13% were in younger adults (ages 20 to under 40), while 87% were in older adults (ages 40 and older).

Among the younger patients in the study, hospitalizations related to AILD tripled from 34 per 100,000 in 2005 to 102 per 100,000 in 2021 (increasing from 19.5 to 74.8 in younger women and from 47.9 to 128.9 in younger men). For the older patients, AILD-related hospitalizations increased from 178 to 273 per 100,000 (from 88.6 to 157.1 in women and from 278.9 to 403.41 in men).

Of the 27,447 AILD-related liver transplants, 75% were in men and 90% involved the older group of adults.

Among the younger patients, liver transplants increased tenfold, from 0.7 per million in 2005 to 7.3 per million in 2021 (increasing from 0.2 to 5.3 in younger women and from 1.8 to 9.2 in younger men). Transplants in older patients nearly doubled, from 9.2 to 17.8 per million (from 2.8 to 10 in women and from 16.5 to 26.5 in men).

As a limitation of the study, Molinari and colleagues pointed out that the NIS tracks hospitalizations rather than individual patients. They also could not account for the potential influence of obesity or viral hepatitis.

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