COVID-19 Aftershocks on Alcohol-associated Liver Disease: An Early Cross-Sectional Report from the U.S. Epicenter (Manuscript HEP4-20-0491).

Rutledge, Stephanie M; Schiano, Thomas D; Florman, Sander; Im, Gene Y; Rutledge, Stephanie M.; Schiano, Thomas D.; Im, Gene Y.

Background & Aims Experts have forewarned about the COVID-19 pandemic environment fomenting the rising incidence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). We performed a cross-sectional study of ALD at our liver transplantation (LT) center, located in the initial U.S. epicenter, New York City (NYC). Results Centered around the "stay at home" order date in NY state, 3/22/20, we defined 3 time periods: "pre-COVID" (1/1/20-3/21/20); "COVID-quarantine" (3/22/20-4/22/20); and "declining-COVID" (4/23/20-8/25/20).We found a 62% increase in interhospital patient transfers for ALD from pre-COVID (20/93, 21%) to the declining-COVID period (43/127, 34%). Our inpatient liver census with ALD also increased: 38% pre-COVID, 45% COVID-quarantine and 49% declining-COVID.Among 30 severe AH patients not responding to medical therapy since 3/22/20, 9 underwent early LT for AH (16% of the total number of early LT during our 8-year program). Three of 9 early LT recipients reported specific COVID-related stressors.All 25 previous LT recipients with established abstinence pre-COVID maintained abstinence at follow-up visits during declining-COVID period. Of 6 recipients with sustained alcohol use within 6 months before 3/22/20, half regained abstinence during the declining-COVID period. Conclusion Our findings help confirm the predictions of rising AUD and ALD as an immediate consequence of the COVID-19 pandemic. This aftershock particularly affected ethnically diverse ALD patients with high inpatient mortality, reflecting the disproportionate impact of COVID-19 on underserved and minority populations.Alcohol relapse did not occur in long-term early LT for AH recipients during the time of COVID-19. This lends further support to AH being a viable indication for LT, with recipients able to demonstrate ongoing resilience in the face of this unprecedented universal stressor.