Background & Aims: Experts have forewarned about the COVID-19 pandemic environment fomenting the rising incidence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). We performed a cross-sectional study of ALD at our liver transplantation (LT) center, located in the initial U.S. epicenter, New York City (NYC). Results: Centered around the "stay at home" order date in NY state, 3/22/20, we defined 3 time periods: "pre-COVID" (1/1/20-3/21/20); "COVID-quarantine" (3/22/20-4/22/20); and "declining-COVID" (4/23/20-8/25/20).We found a 62% increase in interhospital patient transfers for ALD from pre-COVID (20/93, 21%) to the declining-COVID period (43/127, 34%). Our inpatient liver census with ALD also increased: 38% pre-COVID, 45% COVID-quarantine and 49% declining-COVID.Among 30 severe AH patients not responding to medical therapy since 3/22/20, 9 underwent early LT for AH (16% of the total number of early LT during our 8-year program). Three of 9 early LT recipients reported specific COVID-related stressors.All 25 previous LT recipients with established abstinence pre-COVID maintained abstinence at follow-up visits during declining-COVID period. Of 6 recipients with sustained alcohol use within 6 months before 3/22/20, half regained abstinence during the declining-COVID period. Conclusion: Our findings help confirm the predictions of rising AUD and ALD as an immediate consequence of the COVID-19 pandemic. This aftershock particularly affected ethnically diverse ALD patients with high inpatient mortality, reflecting the disproportionate impact of COVID-19 on underserved and minority populations.Alcohol relapse did not occur in long-term early LT for AH recipients during the time of COVID-19. This lends further support to AH being a viable indication for LT, with recipients able to demonstrate ongoing resilience in the face of this unprecedented universal stressor.
COVID-19 Aftershocks on Alcohol-associated Liver Disease: An Early Cross-Sectional Report from the U.S. Epicenter (Manuscript HEP4-20-0491)