P1165 - Two Decades on: What Has Changed in Liver Transplantation in the Twenty First Century

Reem Q.. Al Shabeeb, MD¹, Kathryn Hobbs, MD², Dipam Shah, MD², Veronica Nguyen, MD³, Marwan Abougergi, MD^4
1Inova Fairfax Medical Campus, Silver Spring, MD; ²Inova Fairfax Medical Campus, Fairfax, VA; ³Inova Health System, Fairfax, VA; ⁴Inova Health System, Falls Church, PA

Introduction: Since 1963, liver transplantation has undergone significant advancements reflecting improvements in surgical techniques, immunosuppression, and patient management. Additionally, policy and allocation changes have influenced donor availability, eligibility criteria and transplant accessibility. This study examines the impact of these key developments on liver transplantation over the past two decades.

Methods: This is a retrospective cohort study using the national inpatient database. Outcomes were examined every 5 years from 2001 to 2021. Patients were identified using using procedural ICD-9/10 CM codes indicating a liver transplantation. The primary outcome was indication for liver transplantation. The secondary outcomes were patient’s characteristics, inpatient mortality and resource utilization. Costs and charges were adjusted for using the consumer price index. Means were compared using ANOVA test and proportions were compared using Fisher’s exact test.

Results: The annual number of liver transplantation rose steadily from 4,106 to 8,455 in 2021 (105%) (Table 1). 1 Figure 1 shows the indication for liver transplantation over the years.

Hepatitis C was the predominant indication for transplantation (44%), then rapidly decreased to 6.1% in 2021. In contrast, alcohol increased from 11% in 2001 to become the leading transplantation indication in 2021 (32.4%). The prevalence of Metabolic dysfunction-associated steatohepatitis (MASH) also increased 10-folds (1.4% to 16.9%) to become the second transplantation indication in 2021.



Over the years, transplant recipient included a larger proportion of older patients, African Americans and Native Americans, lower-income patients and those insured by Medicare. The proportion of Female remained unchanged, while that of patients with acute alcoholic hepatitis increased from 1.5% in 2001 to 6.7% in 2021. The proportion of patients with Human immunodeficiency virus remained very low (0.5%-1%). In-hospital mortality rate decreased substantially from 7.4% in 2001 to 3.1% in 2021. In contrast, the total hospitalization costs and charges doubled and quadrupled over the same time period, respectively

Discussion: Alcohol is now the leading indication for liver transplantation. Over the years, an increase in patient diversity is seen. The in-hospital mortality rate has substantially decreased since the beginning of the century. Length of stay has remained essentially constant, but total hospitalization costs and charges continue to increase over time.



Disclosures:


Reem Q.. Al Shabeeb, MD¹, Kathryn Hobbs, MD², Dipam Shah, MD², Veronica Nguyen, MD³, Marwan Abougergi, MD⁴. P1165 - Two Decades on: What Has Changed in Liver Transplantation in the Twenty First Century, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.