Younger Patients Needing Liver Transplants Due to Alcohol

There has been an increase in the number of young people, particularly young women, developing liver disease. CU Medicine provider Dr. James Burton, who specializes in liver disease and transplant, discusses this disturbing trend.

AURORA, Co. (KRDO) -- An increase in alcohol consumption during the pandemic, could be leading to more liver transplants in younger patients, according to a Colorado doctor.

Dr. James Burton is CU Medicine transplant hepatologist and a professor of medicine at the University of Colorado Anschutz Medical Campus. He says half of the liver transplants they performed last year were because of alcohol, and most of those were on younger people.

As stay-at-home orders began across cities in the United States as a mitigation strategy for coronavirus transmission, Nielsen reported a 54 percent increase in national sales of alcohol for the week ending March 21, 2020, compared with one year before.

study published in JAMA Network Open found alcohol consumption rose among adults over age 30 by 14 percent during the pandemic, with a 41 percent uptick in women heavily drinking.

This story was originally published by KRDO Newschannel 13. They sat down with Dr. Burton to discuss what he's seen as Medical Director of liver transplantation at the University of Colorado over the last few years.

You're a doctor who has seen a disturbing trend when it comes to liver transplants in younger patients. Can you explain what you've noticed recently?

Dr. Burton: "Even before the COVID pandemic started, there was quite an increase in the number of young people, particularly young women, developing liver disease as a consequence of alcohol. There's two types of liver disease from alcohol. There's an acute insult that occurs from heavy alcohol use over a relatively short period of time that can cause severe inflammation in the liver. And when that occurs, it can lead to cirrhosis. We do take care of a lot of people in my practice who have end-stage liver disease or cirrhosis as a consequence of alcohol. But there have been a lot of increases in these people with acute alcohol-associated hepatitis from heavy alcohol use. And like I said, this was going up before the pandemic. But once the pandemic occurred, and there were stay-at-home orders, there were dramatic increases in the number of people developing alcohol-associated hepatitis. Those patients did appear to be a lot younger than we've seen in the past. I've been in this business for two decades, and I used to take care of, you know, old men who had cirrhosis. Now, I take care of young women who have acute alcohol-associated hepatitis. I've seen women as young as their early twenties developing liver failure that really can only be saved with the liver transplant."

Is transplantation usually the treatment for liver disease? What is the course of action?

Dr. Burton: "If someone has alcohol-associated liver disease, obviously the one thing that is very important is abstinence from alcohol. There are some hospitals that have six-month rule of being sober from alcohol. At the University of Colorado, we don't have an absolute period of sobriety that is required. One that's encouraged is that if someone quits drinking, sometimes their liver disease can get better to the point where you don't need a liver transplant. When people have a severe acute alcohol-associated hepatitis, oftentimes this is something that's not going to get better without a transplant, and someone doesn't have six months to be sober to see if it's going to get better. They'll probably have died before that. So, the main treatment would be sobriety. And then there are some treatments for alcohol-associated hepatitis A, steroids can be used. In severe cases, though, if steroids don't work, there's a high mortality, you know, 50, 80 percent mortality of people dying within a matter of a month without a liver transplant."

How much does somebody need to be drinking to require treatment or a transplant?

Dr. Burton: "Well, moderate drinking depends on whether you're a male or a female. Men can drink more than women. A lot of that has to do with body composition of fat, and how much water we have in our bodies and stuff. Moderate drinking though would be one drink a day for a woman, and 2 to 3 drinks a day for a man. You define a drink as a 4 percent beer, five ounces of wine, one and a half ounces of liquor. You know, there are a lot of craft beer breweries here in Colorado where a beer can have 8 to 12 percent alcohol. That's 2 to 3 beers. Heavy drinking would be anything greater than one drink for a woman, and up to 4 to 5 for a man. Binge drinking is where one is drinking four drinks for a woman or five drinks for a man multiple times a month. And that's what we've seen a lot in the COVID pandemic: people are doing more binge drinking, more drinking in general. I think a lot of that had to do with being at home, doing meetings on Zoom, Happy Hours starting earlier. You lost your friends, you didn't have resources that you may have used to keep you from drinking as much, like Alcoholics Anonymous, or seeing your psychiatrist. And you know, only 10 percent of heavy drinkers often develop liver disease. So there are a lot of heavy drinkers out there with alcohol use disorders who probably don't develop liver disease, so you can't just say 'well, I drink as much as my friend or my boyfriend and think that I'm okay,' because it's very individualized for the person."

Alcohol problems can be tough for people to talk about. It can be embarrassing. Can you tell if a patient has a problem even if they're not admitting that to you? Can you tell on their scans or other health charts?

Dr. Burton: "Oh, absolutely. I can often tell just by reviewing a patient's labs, their imaging of alcohol-associated liver disease causes a lot of fat to deposit in the liver. If I'm seeing someone who's underweight and has no risk factors for fatty liver disease, that's a big, big red flag for me that this is probably alcohol. There's characteristic patterns of liver enzymes that look like alcohol. So I think I often have a high suspicion for alcohol. Then it's trying to get the patients to have the history that matches what I'm thinking. Obviously, it's very difficult when a patient is denying any alcohol use and everything points to alcohol. That person's in real big trouble because we're not going to transplant someone who denies drinking alcohol, who has clear evidence of alcohol-associated liver disease."

When you say that you're seeing younger patients, how young are we talking?

Dr. Burton: "Like I said, I used to see a lot of people in their fifties and sixties who were men with cirrhosis, and now we're seeing people in their late twenties and thirties. There was a recent study that came out that showed deaths from alcohol use in America have gone up 35 to 40 percent in those age groups of 20 and 30-year-olds, and we're certainly seeing that in our clinics. We used to evaluate 6 to 7 people per week for transplant, and we're evaluating 12 to 13 patients a week. 80 percent of these patients have alcohol-associated liver disease. 50 percent of the transplants we did last year at the University of Colorado were for alcohol. That's not unique here in Colorado. Across the country, it's about 40 percent, and it is increasing. So this is a huge problem, one that was a problem before the pandemic. But I think the pandemic, in a sense, lit it on fire. I think it also goes along with a problem with mental health in America. With the pandemic, we saw increasing use of alcohol. We also saw people having increasing anxiety and depression that was often being treated with alcohol. While alcohol can make you feel a little bit better in the short term, in the long term it's not a good treatment for those conditions."

What do you think are maybe the societal issues that are leading to alcohol consumption?

Dr. Burton: "There used to be only wine, beer, and liquor. Now, there's seltzers that are being sold alcohol in them and alcohol is becoming easier to drink. I think the opportunities for drinking alcohol, the acceptance of alcohol, is becoming greater. I think drinking is something we see in social media, we see it on TV, and we're maybe not doing a very good job of educating people about the dangers. You know, I have a daughter that's in college and I'm thinking, well, gosh, if that's too late to start talking about it, then it might even be too late to be talking about this in high school. Drinking might be something we need to start talking about in grade school. You mentioned people sometimes feel may be embarrassed or, you know, don't want to bring this up to their physicians. But I think primary care doctors need to be asked pointed questions about how much people are drinking and the impact alcohol is having on their lives."

What would you suggest someone do if they think they have a problem?

Dr. Burton: "Well, I think, one: having some insight into recognizing that you have a problem. A lot of times people think moderate alcohol use is probably not as much as they're drinking. But, for a woman that's one drink a day. When you're splitting a bottle of wine with your husband at night and your husband has three glasses and you have two, you're more than moderate drinking. I think, recognizing how much one's drinking, looking at how it's impacting their life, both their relationships, their social interactions, their work. Whether one is having to have a glass of wine when they get home from work to help them unwind. This should be some signs that maybe alcohol is having an impact. If you're looking for someone to help you with, specifically alcohol abuse, or if you're looking for someone to deal with your anxiety or your depression, I think reaching out to your doctor for help with these things, there are some medications one can take to help. There's also some medicines to help take some of the cravings that one might have from alcohol. But ultimately, it's going to require some openness by the person to want to do the work to get better, and it's a lifelong struggle. I tell all my patients who have alcohol-associated liver disease and get a transplant, that we didn't do a brain transplant. We did a liver transplant. And you're still going to have those cravings and we need to give you the tools that you need to maintain sobriety."

What would you say is the biggest takeaway that you would like viewers to leave with from this story?

Dr. Burton: "As I emphasized earlier, 10 percent of heavy drinkers develop liver disease, but alcohol has a big impact on one's life outside of liver disease. It impacts their interactions with their friends and families, their employment, their work relationships. I think it's important that we all kind of take a look at it and reflect on how alcohol might be impacting our life. Obviously, in the line of work that I'm dealing with I deal with the heaviest of use and abuse that caused the irreversible damage that can only be fixed with a liver transplant. I don't need any more business. I'm plenty busy with what we have currently going on, so I think I would really love it if people could really look at themselves and work on trying to reduce the amount of alcohol we're all-consuming."

Is there anything I didn't ask that you want to make sure you mentioned?

Dr. Burton: "In America overall, in all age groups, there's been a 25 percent increase in deaths related to alcohol since 2019. So that certainly is something to emphasize. I think the other thing is that a lot of those deaths were seen in young people in their twenties and thirties. When I see people that started drinking alcohol when they were 12 and 13 years old, that's why they're having severe liver disease at age 20. So I think we all need to kind of realize that this is something we probably need to start educating our children about and the impacts of alcohol. As a society, I think we also need to start looking at some of these impacts like we have done with other things such as tobacco."

TAGS: Alcohol, COVID-19, Liver disease, transplant

CATEGORIES: Conditions and Diseases, Health Education, Surgery

This post was originally posted on April 14, 2022