Liver transplants dramatically extend survival for alcohol-associated liver disease

People with alcohol-associated liver disease who received a liver transplant survived years longer than those who did not, but there are disparities in which patients receive a transplant. A large study published in Alcohol: Clinical and Experimental Research found that liver transplantation was associated with significantly longer survival in both the short term and longer term. Yet, women and African Americans had lower odds of receiving a transplant, even though neither group had a higher risk of death than men or White patients. The study supports the substantial benefit of liver transplantation for people with alcohol-associated liver disease, and highlights a need for policies and practices that ensure equitable access to this life-lengthening treatment.

The study analyzed national insurance claims data of commercially insured and Medicare Advantage patients who were diagnosed with alcohol-associated liver disease from 2017 to 2024, including any pre-existing health issues in the 10 years prior to diagnosis. Unlike most earlier studies, which began follow-up at the time of transplant, this study followed patients from their first diagnosis, capturing the period before transplant when many patients become sicker or die while waiting. The study estimated average survival time within three, five, and eight years after diagnosis. The study design and large national cohort provide a real-world view of liver transplantation outcomes.

Of the more than 370,000 patients in the study, about 3,500 received liver transplants. Those who received a liver transplant lived longer over every follow-up period, with 25 to 45 percent longer average survival time and a 63 percent lower adjusted risk of death. Over the first eight years after diagnosis, transplant recipients lived, on average, about 7.1 years compared to about 4.9 years for people who did not receive a transplant. Because this was an observational study and transplant recipients tended to be younger and healthier in other respects, the authors adjusted for these differences; even so, the findings show an association rather than proof that transplantation alone caused the longer survival.

Differences in who did and did not receive liver transplants were evident by age, sex, race, and coexisting health conditions. Even after adjusting for liver disease severity and comorbidities, disparities persisted, notably among women and African Americans who had lower odds of receiving a liver transplant. People with non-metastatic liver cancer, people with symptoms of liver decompensation, and people with alcohol-associated cirrhosis had increased odds of transplant, whereas people with a recorded diagnosis of alcohol use disorder had less than half the odds. These liver conditions were also associated with a higher risk of death, possibly reflecting delayed referral or advanced disease at the time of transplant evaluation.

The study demonstrates the substantial survival benefit associated with liver transplantation for people with alcohol-associated liver disease, and underscores the need for improvements to ensure equitable systems for referral and treatment to eliminate disparities.