*Purpose: The number of Orthotopic Liver Transplantation (OLT) performed for hepatitis C infection have decreased recently due to direct acting antiviral therapy. However, the number of OLTs for Alcohol-Related Liver Disease (ALD) has increased, but the outcomes for different age groups is not well studied. Therefore, the aim of this study was to evaluate changes in indication for OLT over time and survival among patients transplanted with ALD compared to those without.

*Methods: Patients > 18 years old who underwent OLT from 2002-2019 were identified in the Scientific Registry of Transplant Recipients. The sample was stratified based on etiology of liver disease (ALD versus other) and age at receipt of OLT. Kaplan-Meier survival curves and Cox proportional hazard regression (HR) with 95% confidence intervals were utilized to study patient survival and risk factors associated with death.

*Results: Of the 52,874 patients included in the study, 16,529 (31%) patients were transplanted for ALD, which includes alcohol-related cirrhosis and acute alcohol-related hepatitis. The number of liver transplants being performed for ALD increased significantly each year. From 2013 to 2019, there was a 6.8 % increase in OLT for patients < 40 years old with ALD. Patients transplanted for ALD were younger (53 vs 56 years), more likely to be male (78 vs 61%) and white (78 vs 73%) (all p < 0.01). The median MELD at time of transplant was also higher for ALD compared to others (MELD 26 versus 24, P<0.001). In unadjusted analysis, the overall survival of OLT performed for ALD is the same as other etiologies (HR 1.00, 0.96-1.03). In subgroup analysis, ALD patients < 40 years had a survival advantage compared to those age between 40-59 (HR 1.17, p=0.02) and older than 60 (HR 1.62, p<0.001).After multivariable regression adjusting for multiple demographic variables and MELD score, young ALD patients had equivalent survival after OLT compared to non-alcoholic liver disease (HR 0.91, p=0.22). Finally, young patients with ALD have a significantly increased survival when compared to their older counterpart.

*Conclusions: The rate of liver transplantation for ALD has significantly increased from 2002 to 2019. After multivariable regression, young patients transplanted for ALD have equivalent survival compared to other etiologies.

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