Impact of COVID‐19 pandemic on liver transplantation and alcohol‐associated liver disease in the United States

Cholankeril, George; Goli, Karthik; Rana, Abbas; Hernaez, Ruben; Podboy, Alexander; Jalal, Prasun; Da, Ben L.; Satapathy, Sanjaya K.; Kim, Donghee; Ahmed, Aijaz; Goss, John; Kanwal, Fasiha

BACKGROUND & AIMS: The surge in unhealthy alcohol use during the COVID‐19 pandemic may have detrimental effects on the rising burden of alcohol‐associated liver disease (ALD) on liver transplantation (LT) in the US. We evaluated the impact of the pandemic on temporal trends for LT including ALD. APPROACH & RESULTS: Utilizing data from United Network for Organ Sharing, we analyzed waitlist outcomes in the US through March 1, 2021. In a short‐period analysis, patients listed or transplanted between June 1, 2019 and February 29, 2020 were defined as the “pre‐COVID” era and after April 1, 2020 were defined as the “COVID” era. Interrupted time‐series analyses utilizing monthly count data from 2016‐2020 were constructed to evaluate rate change for listing and LT prior to and during the COVID‐19 pandemic. Rates for listings (P=0.19) and LT (P=0.14) were unchanged during the pandemic despite a significant reduction in the monthly listing rates for HCV (‐21.69%, P <0.001) and NASH (‐13.18%; P <0.001). There was a significant increase in ALD listing (+7.26%; P <0.001) and LT (10.67%; P <0.001) during the pandemic. In the COVID era, ALD (40.1%) accounted for more listings than those due to HCV (12.4%) and NASH (23.4%) combined. The greatest increase in ALD occurred in young adults (+33%) and patients with severe alcoholic hepatitis (+50%). ALD patients presented with a higher acuity of illness, with 30.8% of listings and 44.8% of LT having a MELD‐Na ≥ 30. CONCLUSIONS: Since the start of COVID‐19 pandemic, ALD has become the most common indication for listing and the fastest increasing cause for LT. Collective efforts are urgently needed to stem the rising tide of ALD on healthcare resources.