Table 1:

Key challenges, disparities and opportunities in liver transplantation for alcohol-associated liver disease and their root causes

Challenges	Root Cause(s)	Examples of Opportunities for Future Implementation and Research
Geographic variation in transplant rates for ALD	Differences in regional availability and accessibility of transplant centers, donor organs, and addiction services	Creating Centers of Excellence via Hub and Spoke or Colocated models Testing hybrid telem edicine/in-person models of AUD care
Lower transplant rates for Black patients with ALD	Barriers to referral and evaluation for transplant - lack of insurance, social support, and transportation, possible implicit/explicit bias	Shifting payor policies, Medicaid expansion Leveraging EHR to identify at-risk patients within health systems Understanding patient-, provider-, and system-level barriers to engagement in AUD treatment
Lower transplant rates for women with ALD	Higher mortality and dropout rates on the waitlist, possibly due to more advanced disease, lower MELD scores, and higher rates of infection and sepsis, possible implicit/explicit bias	Increasing provider education and public education about evolving transplant practices Leveraging EHR to identify at-risk patients within health systems
Lower transplant rates for older patients with ALD	Age-related comorbidities, frailty, and reduced life expectancy
Lower post-transplant survival for patients with ALD	Relapse to alcohol use, medication nonadherence, and psychosocial issues	Multidisciplinary programs to reduce post-LT relapse Optimal screening and monitoring strategies for return to alcohol use Standardization of best practices and center resources for addiction support Testing safety and comparative effectiveness of AUD pharmacotherapy in the transplant recipients