Waiting list registration and liver transplantation rates among patients with autoimmune liver disease: An 11-year trend analysis

Abstract

Objectives: We aimed to analyze waiting list and liver transplantation trends for autoimmune liver disease in Argentina.Methods: We designed a population-based analysis of waitlisted or liver transplanted patients for autoimmune hepatitis, primary biliary cholangitis or primary sclerosing cholangitis between 2006-2017 in Argentina. Cumulative incidence rates of waiting list registration and liver transplantation were standardized for age and sex using the 2000 WHO standard population. Joinpoint regression analysis was used to identify changes in waiting list and liver transplantation trends.Results: Waiting list registrations for autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis represented 9.66%, 5.07% and 0.85%.Wait-listing rates for autoimmune hepatitis and primary biliary cholangitis increased significantly between 2006 and 2017, with an annual percentage change of 4.9% (95% CI 0.8 to 9; p=0.01) and 5.5% (95% CI 1 to 10.2; p=0.01) respectively. Patients with autoimmune hepatitis and primary biliary cholangitis aged 40-59 years showed the highest increase in waiting list registration rates. Waiting list registration trends for primary sclerosing cholangitis remained stable: annual percentagechange 1.4% (CI 95% -2.1 to 5; p=0.4). Liver transplantation for autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis represented 10.69%, 5.99% and 3.64%. Liver transplantation trends remained stable in all autoimmune liver diseases.Conclusion: Increasing trends of waiting list registration of autoimmune hepatitis and primary biliary cholangitis may respond to higher diagnosis and early referral rates to liver transplant units. Nevertheless, the growing waitlisting of patients with autoimmune end-stage liver disease underlines an unmet need for effective therapy.