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The Lower Survival in Patients With Alcoholism and Hepatitis C Continues in the DAA Era
Paul J Thuluvath1,2, Waseem Amjad1, Jose Russe-Russe1
1Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD.
Insights
Patients with alcohol liver disease and hepatitis C (AHC) undergoing liver transplantation have worse long-term survival compared to those with only alcohol liver disease. These poorer outcomes persist even after direct-acting antiviral agents became available.
Area of Science:
- Hepatology
- Transplantation Medicine
- Viral Hepatitis Research
Background:
- Alcohol liver disease (ALD) and hepatitis C virus (HCV) coinfection are common in liver transplant recipients.
- Understanding the post-transplant outcomes for patients with alcoholic cirrhosis with hepatitis C (AHC) is crucial for patient management.
Purpose of the Study:
- To compare post-liver transplantation outcomes between patients with AHC and those with alcoholic cirrhosis (AC) and/or alcoholic hepatitis (AH).
- To evaluate the impact of direct-acting antiviral (DAA) agents on AHC patient survival.
Main Methods:
- Utilized UNOS explant data from 2016-2020.
- Compared survival probabilities using Kaplan-Meier analysis and Cox proportional-hazard regression.
- Analyzed outcomes in the DAA era versus the pre-DAA period.
Main Results:
- Identified 8369 ALD liver transplant recipients; 647 had AHC.
- AHC patients had similar 1-year mortality but higher 3- and 5-year mortality compared to AC/AH.
- Despite improved survival in the DAA era, AHC patients still had worse outcomes and higher malignancy-related mortality.
Conclusions:
- AHC is associated with significantly lower 3- and 5-year post-liver transplant survival compared to ALD without HCV.
- The detrimental effect of AHC on survival persists even in the DAA era.
- Malignancy-related mortality is a notable concern in AHC patients post-transplantation.
Background:
Alcohol liver disease (ALD) may coexist with hepatitis C (HCV) in many transplant recipients (alcoholic cirrhosis with hepatitis C [AHC]). Our objective was to determine whether there were differences in postliver transplantation outcomes of patients with AHC when compared with those with alcoholic cirrhosis (AC) and/or alcoholic hepatitis (AH).
Methods:
Using UNOS explant data sets (2016-2020), the survival probabilities of AC, AH, and AHC were compared by Kaplan-Meier survival analysis. Cox proportional-hazard regression analysis was used to determine outcomes after adjusting for disease confounders. The outcomes were also compared with predirect antiviral agent (DAA) period.
Results:
During study period, 8369 biopsy-proven ALD liver transplant recipients were identified. Of those, 647 had AHC (HCV + alcohol), 353 had AH, and 7369 had AC. MELD-Na score (28.7 ± 9.5 versus 23.8 ± 10.7; P < 0.001) and presence of ACLF-3 (19% versus 11%; P < 0.001) were higher in AC + AH as compared with AHC. AHC and AC+AH has similar adjusted mortality at 1-y, but 3-y (hazard ratios, 1.76; 95% confidence intervals, 1.32-2.35; P < 0.0001) and 5-y (hazard ratios, 1.64; 95% confidence intervals, 1.24-2.15; P = 0.0004) mortality rates were higher in AHC. Survival improved in the DAA era (2016-2020) compared with 2009 to 2013 in AHC, but remained worse in AHC group versus AC and/or AH. Malignancy-related mortality was higher in AHC (15% versus 9.3% in AC) in the DAA era.
Conclusions:
AHC was associated with lower 3- and 5-y post-LT survival as compared with ALD without HCV and the worse outcomes in AHC group continued in the DAA era.
