Twenty-year Comparative Analysis of Patients With Autoimmune Liver Diseases on Transplant Waitlists.

Abstract

BACKGROUND & AIMS The rarity of autoimmune liver disease poses challenges to epidemiology studies. However, waitlists for liver transplantation can be used to study patients with end-stage liver diseases. We used these waitlists to assess trends in numbers and demographics patients awaiting liver transplant for primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH). METHODS We collected data from United Kingdom (UK) and United States (US) national registries for all adults on liver transplant waitlists, from January 1, 1995 through December 31, 2014. We analyzed from data on patients with PBC (n=1434 in the UK and n=5598 in the US), PSC (n=1093 in the UK and n=6820 in the US), and AIH (n=538 in the UK and n=4949 in the US). Numbers of listings per year were adjusted to the estimated populations during each year. Regression analyses were used to examine trends and comparative statistics used to evaluate differences in individual characteristics among groups. RESULTS Over the total study period, listings for PBC were 1.2 and 1.0 per million population per year in the UK and US respectively; for PSC, 0.9 and 1.2 per million population per year; and for AIH, 0.5 and 0.8 per million population per year. Over the period studied, numbers of listings for PBC decreased by 50% in both countries; changes in numbers of listings for PSC and AIH were smaller and not consistent between countries. By 2014, PSC had become the leading indication for liver transplantation among patients with autoimmune liver diseases in both countries. Median patient ages at time of listing were lower than those reported as median age of diagnosis for AIH and PBC. The ratio of women:men with PBC decreased by almost 50% from 1995 through 2014. Men with PSC were placed on the waitlist with higher disease severity scores than women in both countries. Among patients with PBC, those of black race were under-represented on waitlists from both countries. Among patients with PSC, Hispanics were under-represented on waitlists in the US. Patients of non-white races were placed on waitlists at younger ages for all diseases; age differences in waitlist placement varied by up to 10 years, depending on race, among patients with PBC. CONCLUSION In an analysis of data collected from UK and US national liver transplant registries over 20 years, we found that PSC has become the leading indication for liver transplantation among patients with autoimmune liver diseases. Numbers of patients with PBC placed on waitlists, and the ratio of women:men with PBC, each decreased by almost 50%, possibly due to increased treatment with ursodeoxycholic acid. Within groups of patients on the transplant waitlisted for PBC, PSC, or AIH, we found differences in age, sex, disease severity scores, and ethnicity between diseases and countries that require further study.

DOI: 10.1016/j.cgh.2017.09.062

Cite this paper

@article{Webb2017TwentyyearCA, title={Twenty-year Comparative Analysis of Patients With Autoimmune Liver Diseases on Transplant Waitlists.}, author={Gwilym J Webb and Akansha Rana and James Hodson and M Z Akhtar and James Walter Ferguson and James M. Neuberger and John Moore Vierling and Gideon M . Hirschfield}, journal={Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association}, year={2017} }