Young women with ALD at high risk of death after liver transplantation

Women aged <40 years with alcohol-associated liver disease (ALD) remain at risk of mortality beyond 1 year after liver transplantation (LT), and the most common cause of death was recurrent disease or explicit mention of alcohol, a study has found.

Sex-specific analyses were carried out using the United Network for Organ Sharing registry because of a significant interaction between sex and the explanatory variable, age. The authors used Cox regression with overall post-LT death as the primary outcome, adjusted for survival characteristics and centre clustering. They also calculated the absolute difference in adjusted 5-year post-LT survival between patient groups. Causes of death were supplemented by a manual review of free-text entries.

A total of 42,014 LT recipients were included, of whom 16,190 were women (2,782 with ALD and 13,408 without ALD) and 25,824 were men (9,502 with ALD and 16,322 without ALD).

Participants aged 40–50 years had the lowest risk of mortality. Those with ALD aged <40 years had incrementally lower adjusted 5-year survival: 74 percent (95 percent confidence interval [CI], 63–88 percent) for those aged 18–29 years, 82 percent (95 percent CI, 78–87 percent) for those aged 30–39 years, and 90 percent (95 percent CI, 88–92 percent) for those aged 40–49 years.

The adjusted 5-year survival for ages 18–29, 30–39, and 40–49 years was similar among women without ALD, men with ALD, and men without ALD. Significant interactions were also found between younger age and ALD among women, but not men.

Adjusted hazard for mortality for women with vs without ALD was higher for those who are younger than 40 years (aged 18–29 years: 2.82 vs 1.09; p=0.002; aged 30–39 years: 1.83 vs 1.09; p=0.007; reference age, 40–49 years). Of note, women with ALD aged 18–29 and 30–39 years had an absolute excess in adjusted 5-year mortality of 17.7 percent and 9.5 percent, respectively, compared with similarly aged women without ALD.