Role of Social Determinants and Outcomes of Patients with Alcohol-Associated Liver Disease Referred for Early Liver Transplantation: A Multicenter Analysis.

Abstract

Liver transplantation (LT) before 6 months sobriety (early LT) for alcohol-associated liver disease (ALD) improves survival with acceptable relapse rates. Patients with disadvantaged social determinants of health (SDOH) may have disparate access to early LT and outcomes, though it is unclear. This was a retrospective study of the Recovery, Survival, and Outcomes in ALD (RESOLVE-ALD) consortium, which includes ALD patients referred for early LT across 6 centers in the United States from 2018-2021. The Area Deprivation Index (ADI) estimated area-level SDOH, and patients were stratified into Low (ADI<50) and High ADI (ADI=50). 607 patients were evaluated for early LT; 25% resided in High ADI areas, and 73.8% in Low ADI. Those in High ADI areas were more likely to be minority race/ethnicity and traveled further to LT centers (p<0.001). After adjusting for clinicodemographic covariates, increasing ADI were associated with higher risks of waitlist (sHR 1.01, 95%CI 1.01-1.03) and post-LT (1.02, 95%CI 1.00-1.05) mortality, though LT receipt (sHR 1.00, 95% 0.99-1.01) and risks of relapse (HR 1.00, 95%CI 0.99-1.01) were similar. Satisfactory ALD-related endpoints may be achieved among select candidates, though patients who reside in vulnerable SDOH areas have lower pre- and post-LT survival, suggesting disparate LT care.

View details for DOI 10.1016/j.ajt.2025.12.282

View details for PubMedID 41475497