المؤلفون: Feld, Jordan J, King, Wendy C, Ghany, Marc G, Chang, Kyong-Mi, Terrault, Norah, Perrillo, Robert P, Khalili, Mandana, Hinerman, Amanda S, LA. Janssen, Harry, Lok, Anna S, Network, Hepatitis B Research

المصدر: Clinical Gastroenterology and Hepatology. 21(6)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Hepatitis - B, Prevention, Hepatitis, Chronic Liver Disease and Cirrhosis, Infectious Diseases, Clinical Trials and Supportive Activities, Clinical Research, Liver Disease, Good Health and Well Being, Adult, Male, Humans, Aged, Female, Hepatitis B, Chronic, Hepatitis B virus, Hepatitis B e Antigens, Cohort Studies, Cross-Sectional Studies, Hepatitis B Surface Antigens, Alanine Transaminase, DNA, Viral, Immune Tolerance, Chronic HBV Infection, Immune Active, Immunotolerant, Phase Transition, Hepatitis B Research Network, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background & aimsMost patients in the immunotolerant (IT) phase of chronic hepatitis B (CHB) transition to the immune active (IA-hepatitis B surface antigen [HBeAg]+) phase by early adulthood. We examined characteristics of adults in the IT vs IA-HBeAg+ phase and rate of transition from IT to other phases of CHB, with a focus on those ≥40 years.MethodsDemographic, clinical, and virologic characteristics of participants in the Hepatitis B Research Network adult cohort study with IT CHB (alanine aminotransferase ≤1.5 × upper limit of normal, hepatitis B virus DNA >107 IU/mL) were compared by age category, and to those with IA-HBeAg+ CHB in cross-sectional analysis. This study received institutional review board approval at all participating centers.ResultsOf 107 adult IT participants, 52 (48%) were

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1z80b9x1Test
https://escholarship.org/content/qt1z80b9x1/qt1z80b9x1.pdfTest

المؤلفون: Huang, Daniel Q, Terrault, Norah A, Tacke, Frank, Gluud, Lise Lotte, Arrese, Marco, Bugianesi, Elisabetta, Loomba, Rohit

المصدر: Nature Reviews Gastroenterology & Hepatology. 20(6)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Substance Misuse, Prevention, Emerging Infectious Diseases, Liver Disease, Chronic Liver Disease and Cirrhosis, Hepatitis, Alcoholism, Alcohol Use and Health, Infectious Diseases, Digestive Diseases, Aetiology, 2.4 Surveillance and distribution, Oral and gastrointestinal, Infection, Good Health and Well Being, Humans, Non-alcoholic Fatty Liver Disease, Liver Cirrhosis, Risk Factors, Liver Cirrhosis, Alcoholic, Hepatitis C, Medical Biochemistry and Metabolomics, Gastroenterology & Hepatology, Clinical sciences

الوصف: Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. Owing to the rising prevalence of obesity and increased alcohol consumption on the one hand, and improvements in the management of hepatitis B virus and hepatitis C virus infections on the other, the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. Although viral hepatitis remains the leading cause of cirrhosis worldwide, the prevalence of non-alcoholic fatty liver disease (NAFLD) and alcohol-associated cirrhosis are rising in several regions of the world. The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8xd4374jTest

المؤلفون: Jain, Ajay Kumar, Buchannan, Paula, Yates, Katherine P, Belt, Patricia, Schwimmer, Jeffrey B, Rosenthal, Philip, Murray, Karen F, Molleston, Jean P, Scheimann, Ann, Xanthakos, Stavra A, Behling, Cynthia A, Hertel, Paula, Nilson, Jamie, Neuschwander-Tetri, Brent A, Tonascia, James, Vos, Miriam B, Cavallo, Laurel, Garner, Donna, Hertel, Paula M, Mysore, Krupa R, Ortega, Taira Illescas, Tessier, Mary Elizabeth, Triggs, Nicole, Tsai, Cynthia, Arce-Clachar, Ana Catalina, Bramlage, Kristin, Cecil, Kim, Mouzaki, Marialena, Popelar, Ann, Trout, Andrew, Xanthakos, Stavra, Allende, Daniela, Bellar, Annette, Dasarathy, Jaividhya, Dasarathy, Srinivasan, Welch, Nicole, Yerrapothu, Rahul, Bashir, Mustafa, Diehl, Anna Mae, Guy, Cynthia, Kopping, Mariko, Piercy, Dawn, Suzuki, Ayako, Alazraki, Adina, Garcia, Carmen, Jara-Garra, Jorge, Karpen, Saul, Vos, Miriam, Chalasani, Naga, Cruz, Mandy, Cummings, Oscar W, Garrison, Lisa, Gawrieh, Samer, Adams, Kathryn Harlow, Jarasvaraparn, Chaowapong, Klipsch, Ann, Morlan, Wendy, Ragozzino, Emily, Samala, Niharika, Vuppalanchi, Raj, Angkanaworakul, Pannapat, Berihun, Achashman, Buysse, Andrew, Dorrian, Theresa, Gulati, Breanna, Kowdley, Kris V, Liu, Kevin, Misic, Sandra, Sohal, Adam, Anthony, Angela, Chapin, Catherine, Fishbein, Mark H, Carpenter, Danielle, Cattoor, Theresa, Freebersyser, Janet, Jain, Ajay K, Ajmera, Veeral, Alba, Amy, Behling, Cynthia, Goyal, Nidhi, Keyvan, Leila, Loomba, Rohit, Madamba, Egbert, Middleton, Michael S, Morfin, Rebecca, Newton, Kimberly, Richards, Lisa, Singh, Seema, Sirlin, Claude, Skonieczny, Jaret, Ugalde-Nicalo, Patricia, Wang, Andrew, Awe, Remilekun, Gill, Ryan, Hameed, Bilal, Olvera, Daisy, Terrault, Norah

المصدر: Hepatology Communications. 7(12)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Nutrition and Dietetics, Obesity, Digestive Diseases, Nutrition, Prevention, Clinical Research, Clinical Trials and Supportive Activities, Pediatric, Oral and gastrointestinal, Metabolic and endocrine, Good Health and Well Being, Humans, Male, Child, Female, Diet, Healthy, Nutrition Assessment, Lipids, Sugars, Body Weight, Nonalcoholic Steatohepatitis Clinical Research Network, Clinical sciences

الوصف: BackgroundPediatric metabolic-associated fatty liver disease (MAFLD) is a global health problem, with lifestyle modification as its major therapeutic strategy. Rigorous characterization of dietary content on MAFLD in children is lacking. We hypothesized an objectively measured healthier diet would positively modulate MAFLD.MethodsDiet was assessed using the Nutrition Data System for Research in children enrolled from 10 tertiary clinical centers to determine the Healthy Eating Index (HEI, 0-100) and individual food components.ResultsIn all, 119 children were included (13.3 ± 2.7 y), 80 (67%) male, 67 (18%) White, and 90 (76%) Hispanic, with an average body mass index Z-score of 2.2 ± 0.5. Diet was classified as low HEI < 47.94 (n = 39), mid HEI ≥ 47.94 and < 58.89 (n = 41), or high HEI ≥ 58.89 (n=39). Children with high HEI (healthier diet) had lower body weight (p = 0.005) and more favorable lipids. Mean serum triglycerides for low, mid, and high HEI were 163, 148, and 120 mg/dL, respectively; p = 0.04 mid versus high, p = 0.01 low versus high. Mean HDL was 38, 41 and 43 mg/dL; p = 0.02 low vs high. Less severe steatosis was noted with added sugar ≤ 10% of calories (p = 0.03). Higher lobular inflammation is associated with a higher percentage of calories from fat (OR (95% CI) = 0.95 (0.91-1.00), p = 0.04).ConclusionsIn children with MAFLD, high HEI is associated with lower body weight and more favorable lipids, while added sugar and fat intake has individual histologic features. Differential consumption of major dietary components may modify both metabolic risk factors and histologic liver injury, highlighting the importance of objective diet assessments in children with MAFLD.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/7v27t42rTest

المؤلفون: Brandman, Danielle, Boyle, Marie, McPherson, Stuart, Van Natta, Mark L, Sanyal, Arun J, Kowdley, Kris, Neuschwander‐Tetri, Brent, Chalasani, Naga, Abdelmalek, Manal F, Terrault, Norah A, McCullough, Art, Bettencourt, Ricki, Caussy, Cyrielle, Kleiner, David E, Behling, Cynthia, Tonascia, James, Anstee, Quentin M, Loomba, Rohit, Network, Members of the Nonalcoholic Steatohepatitis Clinical Research

المصدر: Alimentary Pharmacology & Therapeutics. 55(11)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Hepatitis, Liver Disease, Chronic Liver Disease and Cirrhosis, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Oral and gastrointestinal, Good Health and Well Being, Adult, Biopsy, Clinical Decision Rules, Cross-Sectional Studies, Female, Fibrosis, Humans, Liver, Liver Cirrhosis, Non-alcoholic Fatty Liver Disease, cirrhosis, nonalcoholic fatty liver disease, noninvasive assessment, Members of the Nonalcoholic Steatohepatitis Clinical Research Network, Pharmacology and Pharmaceutical Sciences, Gastroenterology & Hepatology, Clinical sciences, Pharmacology and pharmaceutical sciences

الوصف: Background and aimsPatients with nonalcoholic fatty liver disease (NAFLD) cirrhosis benefit from referral to subspecialty care. While several clinical prediction rules exist to identify advanced fibrosis, the cutoff for excluding cirrhosis due to NAFLD is unclear. This analysis compared clinical prediction rules for excluding biopsy-proven cirrhosis in NAFLD.MethodsAdult patients were enrolled in the NASH Clinical Research Network (US) and the Newcastle Cohort (UK). Clinical and laboratory data were collected at enrolment, and a liver biopsy was taken within 1 year of enrolment. Optimal cutoffs for each score (eg, FIB-4) to exclude cirrhosis were derived from the US cohort, and sensitivity, specificity, positive predictive value, negative predictive value and AUROC were calculated. The cutoffs were evaluated in the UK cohort.Results147/1483 (10%) patients in the US cohort had cirrhosis. All prediction rules had similarly high NPV (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis (AUROC 0.84-0.86). 59/494 (12%) patients in the UK cohort had cirrhosis. Prediction rules had high NPV (0.92-0.96), and FIB-4 and NAFLD fibrosis score the most accurate in the prediction of cirrhosis in the UK cohort (AUROC 0.87-0.89).ConclusionsThis cross-sectional analysis of large, multicentre international datasets shows that current clinical prediction rules perform well in excluding cirrhosis with appropriately chosen cutoffs. These clinical prediction rules can be used in primary care to identify patients, particularly those who are white, female, and

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6bg9n7jgTest

المؤلفون: Sarkar, Monika A, Suzuki, Ayako, Abdelmalek, Manal F, Yates, Katherine P, Wilson, Laura A, Bass, Nathan M, Gill, Ryan, Cedars, Marcelle, Terrault, Norah, Network, NASH Clinical Research

المصدر: Clinical Gastroenterology and Hepatology. 19(6)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Chronic Liver Disease and Cirrhosis, Women's Health, Contraception/Reproduction, Hepatitis, Liver Disease, Digestive Diseases, Prevention, Aging, Nutrition, Obesity, Oral and gastrointestinal, Good Health and Well Being, Adult, Female, Fibrosis, Humans, Liver, Liver Cirrhosis, Non-alcoholic Fatty Liver Disease, Obesity, Abdominal, Testosterone, Androgens, Hepatic Inflammation, Sex Hormones, Nonalcoholic Fatty Liver Disease, Abdominal Adiposity, NASH Clinical Research Network, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background & aimsHigher testosterone contributes to imaging-confirmed nonalcoholic fatty liver disease (NAFLD) in women, but whether testosterone influences their disease severity is unknown.MethodsThe association of free testosterone (free T) with nonalcoholic steatohepatitis (NASH) was determined in pre-menopausal women with biopsy-confirmed NAFLD (n = 207). Interaction testing was performed for age and free T given decline in testosterone with age, and association of aging with NASH. Regression models adjusted for abdominal adiposity, diabetes, and dyslipidemia.ResultsMedian age was 35 yrs (interquartile range, 29-41); 73% were white, 25% Hispanic; 32% had diabetes, 93% abdominal adiposity, and 95% dyslipidemia. 69% had NASH, 67% any fibrosis, and 15% advanced fibrosis. Higher free T levels were associated with NAFLD severity in younger women (interaction P value

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/56w8n4d8Test
https://escholarship.org/content/qt56w8n4d8/qt56w8n4d8.pdfTest

المؤلفون: Sarkar, Monika, Yates, Katherine, Suzuki, Ayako, Lavine, Joel, Gill, Ryan, Ziegler, Toni, Terrault, Norah, Dhindsa, Sandeep

المصدر: Clinical Gastroenterology and Hepatology. 19(2)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Chronic Liver Disease and Cirrhosis, Liver Disease, Hepatitis, Digestive Diseases, Obesity, Nutrition, Metabolic and endocrine, Oral and gastrointestinal, Good Health and Well Being, Fibrosis, Humans, Liver, Male, Non-alcoholic Fatty Liver Disease, Testosterone, Gastroenterology & Hepatology, Clinical sciences

الوصف: With rising prevalence of obesity and diabetes, nonalcoholic fatty liver disease (NAFLD) is now a leading cause of chronic liver disease. One-third of obese or diabetic men have subnormal free and bioavailable testosterone concentrations.1 Several studies have further shown low testosterone to be associated with imaging-confirmed NAFLD in men,2 although it is unknown whether low testosterone confers increased risk of more clinically relevant manifestations of NAFLD, including nonalcoholic steatohepatitis (NASH) and NASH fibrosis. We therefore aimed to evaluate the association of testosterone with histologic features of NAFLD among a representative cohort of men from the multicenter NASH Clinical Research Network (NASH CRN).

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/7zk0x6j8Test

المؤلفون: Verna, Elizabeth C, Serper, Marina, Chu, Jaime, Corey, Kathleen, Fix, Oren K, Hoyt, Karen, Page, Kimberly A, Loomba, Rohit, Li, Ming, Everson, Gregory T, Fried, Michael W, Garcia‐Tsao, Guadalupe, Terrault, Norah, Lok, Anna S, Chung, Raymond T, Reddy, K Rajender

المصدر: Hepatology. 72(5)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Clinical Research, Digestive Diseases, Good Health and Well Being, Biomedical Research, COVID-19, Coronavirus Infections, Delivery of Health Care, Female, Forecasting, Gastroenterology, Humans, Male, Needs Assessment, Pandemics, Pneumonia, Viral, Program Development, Program Evaluation, Research Design, Telemedicine, United States, Medical Biochemistry and Metabolomics, Immunology, Gastroenterology & Hepatology, Clinical sciences

الوصف: The severe acute respiratory syndrome coronavirus 2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C and studying the natural history of many forms of chronic liver disease. National Institutes of Health, foundation, and industry funding have provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously, however, all nonessential research activities were halted when the pandemic started, forcing those involved in clinical research to rethink their research strategy, including a shift to coronavirus disease 2019 research while endeavoring to maintain their preexisting agenda. Strategies to maintain the integrity of ongoing studies, including patient follow-up, safety assessments, and continuation of investigational products, have included a shift to telemedicine, remote safety laboratory monitoring, and shipping of investigational products to study subjects. As a revamp of research is being planned, unique issues that face the research community include maintenance of infrastructure, funding, completion of studies in the predetermined time frame, and the need to reprogram career path timelines. Real-world databases, biomarker and long-term follow up studies, and research involving special groups (children, the homeless, and other marginalized populations) are likely to face unique challenges. The implementation of telemedicine has been dramatically accelerated and will serve as a backbone for the future of clinical research. As we move forward, innovation in clinical trial design will be essential for conducting optimized clinical research.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2m83m8gvTest

المؤلفون: Loomba, Rohit, Neuschwander‐Tetri, Brent A, Sanyal, Arun, Chalasani, Naga, Diehl, Anna Mae, Terrault, Norah, Kowdley, Kris, Dasarathy, Srinivasan, Kleiner, David, Behling, Cynthia, Lavine, Joel, Van Natta, Mark, Middleton, Michael, Tonascia, James, Sirlin, Claude, Network, for the NASH Clinical Research

المصدر: Hepatology. 72(4)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Clinical Research, Clinical Trials and Supportive Activities, Liver Disease, Hepatitis, Chronic Liver Disease and Cirrhosis, Biomedical Imaging, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Oral and gastrointestinal, Adipose Tissue, Adult, Aged, Chenodeoxycholic Acid, Double-Blind Method, Female, Humans, Liver, Magnetic Resonance Imaging, Male, Middle Aged, Non-alcoholic Fatty Liver Disease, Protons, Weight Loss, NASH Clinical Research Network, Medical Biochemistry and Metabolomics, Immunology, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background and aimsEmerging data from a single-center study suggests that a 30% relative reduction in liver fat content as assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) from baseline may be associated with histologic improvement in nonalcoholic steatohepatitis (NASH). There are limited multicenter data comparing an active drug versus placebo on the association between the quantity of liver fat reduction assessed by MRI-PDFF and histologic response in NASH. This study aims to examine the association between 30% relative reduction in MRI-PDFF and histologic response in obeticholic acid (OCA) versus placebo-treated patients in the FLINT (farnesoid X receptor ligand obeticholic acid in NASH trial).Approach and resultsThis is a secondary analysis of the FLINT trial including 78 patients with MRI-PDFF measured before and after treatment along with paired liver histology assessment. Histologic response was defined as a 2-point improvement in nonalcoholic fatty liver disease activity score without worsening of fibrosis. OCA (25 mg orally once daily) was better than placebo in improving MRI-PDFF by an absolute difference of -3.4% (95% confidence interval [CI], -6.5 to -0.2%, P value = 0.04) and relative difference of -17% (95% CI, -34 to 0%, P value = 0.05). The optimal cutoff point for relative decline in MRI-PDFF for histologic response was 30% (using Youden's index). The rate of histologic response in those who achieved less than 30% decline in MRI-PDFF versus those who achieved a 30% or greater decline in MRI-PDFF (MRI-PDFF responders) relative to baseline was 19% versus 50%, respectively. Compared with MRI-PDFF nonresponders, MRI-PDFF responders demonstrated both a statistically and clinically significant higher odds 4.86 (95% CI, 1.4-12.8, P value

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/57t3875sTest

المؤلفون: Sarkar, Monika, Grab, Joshua, Dodge, Jennifer L, Gunderson, Erica P, Rubin, Jessica, Irani, Roxanna A, Cedars, Marcelle, Terrault, Norah

المصدر: Journal of Hepatology. 73(3)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Pediatric, Infant Mortality, Clinical Research, Prevention, Perinatal Period - Conditions Originating in Perinatal Period, Chronic Liver Disease and Cirrhosis, Liver Disease, Hypertension, Contraception/Reproduction, Digestive Diseases, Preterm, Low Birth Weight and Health of the Newborn, Reproductive health and childbirth, Good Health and Well Being, Adult, Comorbidity, Diabetes, Gestational, Eclampsia, Female, Fetal Death, Gestational Age, Humans, Infant, Newborn, Maternal Mortality, Non-alcoholic Fatty Liver Disease, Postpartum Hemorrhage, Pre-Eclampsia, Pregnancy, Premature Birth, Prevalence, Retrospective Studies, United States, Non-alcoholic steatohepatitis, Reproductive health, Complications, Chronic liver disease, Clinical Sciences, Public Health and Health Services, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background & aimsThe prevalence of non-alcoholic fatty liver disease (NAFLD) is rising in young adults, with potential implications for reproductive-aged women. Whether NAFLD during pregnancy confers more serious risks for maternal or perinatal health is unclear.MethodsUsing weighted discharge data from the US national inpatient sample, we evaluated temporal trends of NAFLD in pregnancies after 20 weeks gestation, and compared outcomes to pregnancies with other chronic liver diseases (CLDs) or no CLD. Study outcomes included preterm birth, postpartum hemorrhage, hypertensive complications (pre-eclampsia, eclampsia, and/or hemolysis, elevated liver enzymes, and low platelets syndrome), and maternal or fetal death. NAFLD prevalence was estimated by calendar year and temporal trends tested by linear regression. Outcomes were analyzed by logistic regression adjusted for age, race, multiple gestation, and pre-pregnancy diabetes, obesity, dyslipidemia and hypertension.ResultsAmong 18,574,225 pregnancies, 5,640 had NAFLD and 115,210 had other, non-NAFLD CLD. Pregnancies with NAFLD nearly tripled from 10.5/100,000 pregnancies in 2007 to 28.9/100,000 in 2015 (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4pj0w9ghTest
https://escholarship.org/content/qt4pj0w9gh/qt4pj0w9gh.pdfTest

المؤلفون: Lee, Brian P, Vittinghoff, Eric, Pletcher, Mark J, Dodge, Jennifer L, Terrault, Norah A

المصدر: Hepatology. 72(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Immunology, Transplantation, Liver Disease, Clinical Research, Substance Misuse, Chronic Liver Disease and Cirrhosis, Alcoholism, Alcohol Use and Health, Digestive Diseases, Hepatitis, Good Health and Well Being, Female, Health Policy, Humans, Liver Diseases, Alcoholic, Liver Transplantation, Male, Medicaid, Middle Aged, Prospective Studies, United States, Medical Biochemistry and Metabolomics, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background and aimsIn some states, liver transplantation (LT) for alcohol-associated liver disease (ALD) is covered by Medicaid only with documentation of abstinence and/or alcohol rehabilitation. Different Medicaid policies may affect the distribution of LT for ALD, particularly post-2011, as centers have adopted early (i.e., specific abstinence period not required) LT practices.Approach and resultsWe surveyed Medicaid policies in all states actively performing LT and linked state policies to prospectively collected national registry data on LT recipients from 2002 to 2017 with ALD as the primary listing diagnosis. We categorized Medicaid policies for states as "restrictive" (requiring documentation of a specific abstinence period and/or rehabilitation) versus "unrestrictive" (deferring to center eligibility policies). Difference-of-differences analysis, comparing 2002-2011 versus 2012-2017, evaluated whether restrictive policies were associated with decreased proportion of LTs paid by Medicaid among patients with ALD post-2011. We performed sensitivity analyses to account for any differences by diagnosis of hepatocellular carcinoma, hepatitis C virus, nonalcoholic steatohepatitis, or Medicare insurance. We also performed a sensitivity analysis to account for any difference by prevalence of ALD among restrictive versus unrestrictive states. Of 10,836 LT recipients in 2002-2017, 7,091 were from 24 states in the restrictive group and 3,745 from 14 states in the unrestrictive group. The adjusted proportion (95% confidence interval) of LTs paid by Medicaid among restrictive versus unrestrictive states between 2002 and 2011 was 17.6% (15.4%-19.8%) versus 18.9% (15.4%-22.3%) (P = 0.54) and between 2012 and 2017, 17.2% (14.7%-19.7%) versus 23.2% (19.8%-26.6%) (P = 0.005). In difference-of-differences analysis, restrictive (versus unrestrictive) policies were associated with a 4.7% (0.8%-8.6%) (P = 0.02) absolute lower adjusted proportion of LTs for ALD paid by Medicaid post-2011.ConclusionsRestrictive Medicaid policies are present in most states with active LT centers and are associated with lower proportions of LTs for ALD paid by Medicaid post-2011 compared to states with unrestrictive Medicaid policies. Reevaluation of Medicaid alcohol use policies may be warranted, to align more closely with contemporary center-level practices.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/39h522d8Test