Women and people from deprived areas are less likely to be assessed for liver transplantation for alcohol-related liver disease: results from a national study of transplant assessments
Oldroyd, Christopher Aluvihare, Varuna Holt, Andrew Chew, Yun Masson, Steven Parker, Richard Rajoriya, Neil Ryan, Jennifer Shepherd, Liz Simpson, Kenneth
Oldroyd, Christopher
Aluvihare, Varuna
Holt, Andrew
Chew, Yun
Masson, Steven
Parker, Richard
Rajoriya, Neil
Ryan, Jennifer
Shepherd, Liz
Simpson, Kenneth
Affiliation
Cambridge University Hospitals NHS Foundation Trust; University of Cambridge; King's College Hospital NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Newcastle upon Tyne Hospitals NHS Foundation Trust; University of Birmingham; Royal Free London NHS Foundation Trust; NHS Lothian; Cambridge and Peterborough NHS Foundation Trust; Office for Health Improvement and Disparities; King's College London
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Publication date
2024-11-05
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Abstract
Background: Alcohol-related liver disease (ArLD) is the most common indication for liver transplantation in Europe and the United States. Few studies have examined the characteristics of patients with ArLD formally assessed for liver transplants.
Methods: We collected prospective data on every patient with ArLD formally assessed for liver transplantation in the United Kingdom during a 12-mo period.
Results: Five hundred forty-nine patients with ArLD were assessed for liver transplantation. The median Model for End-Stage Liver Disease (MELD) score was 15 and the UK MELD score was 54. 24% were women. The median duration of abstinence was 12 mo. Listing outcomes were 59% listed, 4% deferred, and 37% not listed. The reasons for not listing were medical comorbidities (29%), too early for transplantation (20%), potential recoverability (18%), recent alcohol use (12%), and other (21%). Patients listed for transplant had a higher median MELD (16 versus 13; P < 0.001) and UK MELD scores (55 versus 53; P < 0.001), longer duration of abstinence (median 12 versus 10 mo; P = 0.026), and no differences in sex (P = 0.258), age distribution (P = 0.53), or deprivation deciles compared with those not listed. Comparing patients assessed for transplantation to national data on deaths from ArLD revealed a lower proportion of female patients (24% assessed versus 36% deaths; P < 0.001) and patients from areas of high deprivation (assessments: deaths, most deprived decile 1:20 versus least deprived decile 1:9).
Conclusions: This study provides the first complete national profile of evaluations for liver transplantation for patients with ArLD. Women and patients from the most deprived deciles of the population may be relatively underrepresented.
Citation
Oldroyd C, Aluvihare V, Holt A, Chew Y, Masson S, Parker R, Rajoriya N, Ryan J, Shepherd L, Simpson K, Wai C, Webzell I, Walton S, Verne J, Allison MED. Women and People From Deprived Areas Are Less Likely to be Assessed for Liver Transplantation for Alcohol-related Liver Disease: Results From a National Study of Transplant Assessments. Transplant Direct. 2025 Feb 7;11(3):e1761. doi: 10.1097/TXD.0000000000001761
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Article