Introduction: The complexity of indications for liver transplantation poses a growing challenge in modern transplantology. The co-occurrence of viral, neoplastic, and autoimmune diseases, as well as lifestylerelated conditions, is increasingly observed. This study aimed to analyze the etiological and demographic characteristics of recipients of orthotopic liver transplants (OLT) and simultaneous liver and kidney transplants (SLKT), taking into account differences in gender, age, and the proportion of multiple etiologies (2 diagnoses). Methods: Clinical data from a retrospective database of OLT and SLKT recipients from 2008-2024 were cleaned and classified according to a standardized algorithm that allows for the identification of multiple diagnoses. The analysis included age, gender, pre-transplant creatinine level, and the primary cause of liver disease. Particular attention was paid to patient-induced etiologies: alcoholic liver disease (ALD), metabolic dysfunction-associated steatotic liver disease (MASLD), acetaminophen poisoning and death cap mushroom poisoning. Results: 3, 217 OLT and SLKT recipients were included. The mean pretransplant creatinine level was 1. 9 0. 7 mg/dL. The most common single etiology was alcoholic liver disease (ALD, 15%), which increased to over 22% when multiple etiology cases were included. The next most common diagnoses included PSC, HCV, HCC, PBC, AIH, and Wilson's disease. Mixed etiologies affected 36. 9% of recipients (n=1, 189), most commonly HCC with HCV/HBV, or AIH with PSC. Men constituted 62% of all recipients and were more likely to be transplanted at an older age (over 50 years old), while women predominated in younger age groups, primarily with autoimmune diseases (AIH, PBC). Patient-induced etiologies (ALD, MASLD, poisoning) were significantly more common in men and in younger age groups (mean age 479 years), while autoimmune or cholestatic diagnoses predominated in women. Conclusion: Over one-third of liver transplants and SLKT were in multiple etiology patients. Men constituted the majority of recipients, particularly in older groups and with lifestyle-related etiologies (ALD, MASLD, poisoning). Autoimmune diseases predominated in women, diagnosed and considered for transplantation at a younger age. The data indicate the growing importance of multifactorial transplant eligibility and demographic profiling in assessing risk and prognosis after transplantation. I have no potential conflict of interest to disclose. I did not use generative AI and AI-assisted technologies in the writing process.
Li et al. (Wed,) studied this question.