Liver transplant offers lifesaving options for people with long-standing liver damage or cirrhosis and people with liver cancer. The number one reason for liver failure used to be viral hepatitis says Clinical Gastroenterology but has now shifted to alcoholic liver disease (ALD) in the U.S.
Are liver transplants on the rise?
Yes, liver transplants (LT) are going up says UNOS or United Network of Organ Sharing by 7.5 % over 2023 with over 11,000 liver transplants in the United States (U.S.) in 2024. The majority of LT are from deceased doners with a small group from living people who donate a lobe or portion of their liver. Despite this, the demand for organs and liver transplants significantly outstrips our limited supply with 1 out of every 4 people either dying while waiting for a transplant or becoming too sick to receive one.
Why is alcoholic liver disease (ALD) on the rise?
ALD is skyrocketing with a spike up in global alcohol consumption with 2-3 billion people saying they drink on a regular basis and another 40 % admit to heavy alcohol use. This trend was compounded by an alarming rise in alcohol use and sales during the COVID-19 pandemic that is starting to level off.
Social isolation and stress during the pandemic led to higher rates of excessive and binge drinking creating a “happy hour at home,” culture, coupled with increased availability of sweetened beverages like hard or spiked seltzer, a carbonated water drink mixed with fruit flavorings and alcohol, changing social norms around alcohol, and a growing population of women who drink heavily and due to differences in alcohol metabolism than men are more susceptible to getting liver damage.
Alcohol was a problem even before the pandemic says UC Health University in Colorado, with more than half the transplants related to heavy alcohol use where in the past most people who needed transplants had hepatitis C or other diseases not anymore,” Alcohol use was a problem before the pandemic, but the pandemic just lit it on fire.”
Also, we witnessed a dramatic decrease in the U.S. and Europe in the number of people with hepatitis C following the introduction of highly effective direct-acting antivirals (DAAs) shifting the number of people needing transplants from viral hepatitis to other forms of liver failure. Despite advances in treatment for hepatitis, viral hepatitis still remains the main reason for liver transplants in many parts of the world including Southeast Asia, and Africa.
Who gets a liver transplant?
Liver transplants are given to people who are sickest and most critical. In adults in the U.S. this is done by using a scoring system called MELD or Model for end-stage liver disease where the higher the score qualifies you sooner and factors in how well your kidneys are working, blood is clotting, and liver is functioning.
Clinical Gastroenterology and Hepatology, says the number one reason for liver transplant in Europe is alcoholic liver disease (ALD), and in the U.S. 40 % of all liver transplant are due to ALD. Also, the proportion of transplants for non-alcoholic fatty/steatohepatitis (NASH) jumped from 2.5 % in 2004 to 21% in 2019 as a consequence of more people having obesity and diabetes.
In the past people with alcoholic liver disease (ALD) unless they stopped drinking alcohol entirely or abstained for at least 6 months would be excluded from transplant with the assumption they would continue to drink and damage the new liver, but the rules have changed allowing more people with ALD to receive liver transplants sooner.
What are the risks of liver transplants?
There are many risks of liver transplant but remains the most important lifesaving option for many people with cirrhosis with complications, and liver cancer (stage T2 hepatocellular cancer). Risks of liver transplant includes acute rejection of the organ, infection, heart issues, and return of the original liver disease with up to 10 % dying within the first year of their transplant. Those who survive the first year can expect a 5-year survival of 80 % and a 12-year survival of 68 % in the U.S.
The greatest risk of infection is within the first 6 months from surgery as this is the time where the immune system is weakened by high doses of medications used to combat acute rejection of the liver and places the patient at higher risk for life-threatening bacterial, fungal and viral infections including viruses that can be transmitted directly from the new liver to the patient.
Are liver transplants common?
In the U.S. over 11,000 people received liver transplants in 2024 and many more are waiting to be transplanted. Unfortunately, we lost a famous celebrity Michelle Trachtenberg who reportedly had a recent liver transplant. Other famous people to receive liver transplants includes Steve Jobs and James Redford just to name a few.
Liver transplants are done for a variety of reasons including end-stage alcohol liver disease (ALD), non-alcoholic fatty/steatohepatitis (NASH), hepatitis (C and B), auto-immune diseases, genetic causing and even acute liver failure from overdoses with acetaminophen or Tylenol.
Alcoholic liver disease (ALD) is on the rise and is growing particularly in our younger population. We need to increase awareness especially in younger women who are the most venerable to the hazardous effects of heavy alcohol use.
That said, we are fortunate to have the gift of liver transplantation that started 60 years ago with the first successful liver transplant at the VA hospital in Denver, Colorado in a 48-year-old man with liver cancer blazing the trail for future transplants and fast forward to 2024 with 45,000 record-breaking deceased organ transplants in the U.S. with an average of 132 organs transplanted daily saving 39,000 lives.
If you have any questions AskDoctorH, we are here to help.
Have Questions? AskDoctorH