Jahagirdar, Vinay

Bridging locoregional therapy (LRT) is widely used in liver transplant (LT) candidates with hepatocellular carcinoma (HCC) to minimize waitlist dropout and evaluate tumor biology. While transarterial chemoembolization (TACE) has historically been the predominant approach, the role of transarterial radioembolization (TARE) is expanding. Comparative effectiveness data for these 2 modalities as bridging strategies remain limited. This study assessed the trends, factors influencing therapy selection, and outcomes of transarterial bridging LRT. We conducted a retrospective cohort study of adult LT candidates with HCC listed in the Organ Procurement and Transplantation Network (OPTN) between 2016 and 2024 who received TACE or TARE as their sole bridging LRT. Inverse probability weighting (IPW) was applied to balance baseline covariates. Multivariable Fine–Gray competing risk regression and stratified Cox proportional hazards and logistic regression models were used to assess waitlist dropout, complete pathological necrosis (CPN), recurrence, and overall survival. Among 8367 patients, 5472 (65%) received TACE, and 2895 (35%) received TARE. TARE use increased significantly from 22.5% to 51.7% over the study period. TARE was more likely to be used among patients with MASLD, older age, and high tumor burden, and less likely in those with lower socioeconomic status. TARE recipients had a significantly lower risk of waitlist dropout (sHR 0.83, p <0.001) and a higher likelihood of achieving CPN (aOR 2.24, p <0.001). The overall survival did not differ significantly between groups (aHR 0.94, p =0.19). The use of TARE as bridging therapy in HCC LT candidates has surged and is influenced by socioeconomic factors, comorbidities, and tumor burden. TARE effectiveness has been demonstrated by its advantages in waitlist retention and tumor necrosis. Further studies are warranted to evaluate its impact on post-LT recurrence and to validate the cost-effectiveness among transarterial therapies.

ABSTRACTObjectiveAlcohol‐related liver disease (ALD) has emerged as a significant public health concern, particularly among younger populations. ALD remains the leading cause of alcohol‐attributable deaths. This study aims to forecast ALD mortality trends up to 2030, focusing on individuals under 55 years.MethodsWe utilized data from the CDC WONDER database (1999–2022) to examine ALD‐related deaths, identified by ICD‐10 codes (K70.0–K70.9). Crude mortality rates (CMRs) per 100 000 were analyzed and temporal trends were assessed using annual and average annual percent changes (APC/AAPC) with empirical quantile confidence intervals. An Autoregressive Integrated Moving Average (ARIMA) model was employed to project mortality rates until 2030, validated through time series cross‐validation.ResultsFrom 1999 to 2022, there were 181 862 ALD‐related deaths among individuals under 55, with mortality rates increasing from 3.9 per 100 000 in 1999 to 9.7 per 100 000 in 2022 (AAPC 4.66%, 95% CI: 3.90%–5.86%). Projections suggest rates will continue to rise, reaching 14.4 per 100 000 by 2030. From 1999 to 2022, the 25–34 age group experienced the highest increase, with an AAPC of 10.27% (95% CI: 9.19%–11.35%), while the 35–44 and 45–54 age groups showed more moderate increases, with AAPCs of 5.03% and 4.38%, respectively. Projections indicate an AAPC of 3.86% for ages 25–34, 3.90% for ages 35–44, and 6.17% for ages 45–54 by 2030.ConclusionForecasts indicate a continued rise in ALD mortality among individuals under 55, necessitating immediate public health strategies to mitigate this trend.