A significant increase in wait list for a liver transplant correlates with a spike in alcohol sales during the COVID-19 pandemic, a new study has found. Experts warn that Canada may also see an increase in liver disease in the coming months.
A research letter, published in the Journal of the American Medical Association on Tuesday, found that there was a significantly higher rate of registrations on U.S. liver transplant waiting lists from March 2020 to January 2021 compared to before the pandemic. There was also a significant increase in alcohol sales during this same period. This increase was beyond the expected surge due to a backlog of diagnoses caused by the pandemic.
While researchers have yet to confirm if there is a similar trend occurring in Canada, Nem Maksimovic, Senior Manager of Support & Education for the Canadian Liver Foundation, warns that Canada may be facing a similar increase in liver disease.
“Some of the liver specialists I’ve spoken with since the pandemic started have indicated themselves that they have seen a rise in alcohol-related liver disease conditions,” he says. “…there’s likely going to be a spike in transplant wait lists [and] also transplant procedures in the next few years.”
An increase in needed liver transplants will put even more pressure on a system already straining to meet demand. The Canadian Institute for Health Information reported that in 2020, 565 liver transplants occurred, leaving 528 people on the transplant wait list — 122 patients died while waiting.
Not all regions are seeing a post-pandemic spike in transplants. A spokesperson for BC Transplants wrote in an email that they have not seen a significant increase in recent months, however, they cannot comment on other jurisdictions or other forms of liver disease that do not require a transplant.
Canadians already warned about excessive drinking
Researchers from the University of Michigan warn that while they cannot say if the increase in alcohol sales is a direct cause for the spike in needed liver transplants, they do suspect a relationship.
“While we cannot confirm causality, this disproportionate increase in association with increasing alcohol sales may indicate a relationship with known increases in alcohol misuse during COVID-19,” the authors wrote.
In Canada, the Canadian Centre on Substance Use and Addiction previously sounded the alarm bells on the increase in alcohol consumption during the COVID-19 pandemic, prompting chief public health officer Dr. Theresa Tam to ask Canadians to slow it down.
“It is common to look for ways to cope during periods of uncertainty, but I continue to be concerned about the potential risks of increased alcohol use during COVID-19,” Tam said in a December statement.
“I am reminding Canadians to be aware of the impacts of increased alcohol consumption on their health and to find alternative ways of celebrating and coping with stress that respect public health measures in your region.”
Inflammation of the liver caused by excessive alcohol consumption which damages the liver and causes the death of the cells that make up the organ is known alcohol hepatitis (AH), according to Johns Hopkins Medicine.
Symptoms may include nausea, dizziness, vomiting blood or a substance similar in consistency to coffee grounds, stomach or abdominal pain, and jaundice (yellowing of the eyes or skin). Early signs of liver damage may go undetected.
A patient diagnosed with AH typically has an average daily consumption of 80g of ethanol (just under six standard drinks) for more than five years, however, cases of AH caused by excessive daily drinking for as little as 3 months have been reported. The Canadian Liver Foundation recommends no more than 10 standard drinks per week for women with no more than two in a single day, while men should consume no more than 15 drinks per week or three per day.
Maksimovic calls the liver a “resilient” organ and explains that it can often heal if health concerns are caught early.
“It’s actually the only organ that can regenerate itself,” Maksimovic explains. “If somebody gets a liver transplant from a living donor, so myself taking a piece of my liver providing it to you, my half of the liver will grow to full size within eight to 12 weeks, and then, likely, so will yours.”
Early detection is needed to preserve as much of the liver as possible. Anyone concerned about symptoms they are experiencing or their increase in alcohol consumption should speak to a doctor as soon as possible.
Maksimovic pushes back against the stigma experienced by individuals who are diagnosed with liver disease, saying that alcohol is not the only cause. Anyone experiencing symptoms or concerns about their liver should not feel ashamed to have them addressed.
“I think it’s a stigma behind liver disease for people to think that it is strictly alcohol induced. I’m trying to break that stigma to say alcohol is, of course, a big contributor or cause, but it is by far not the only one.”