Women, young people need larger share of surgeries in Colorado

Noting that vodka is cheaper than therapy might be gallows humor for some people, but for Kristen Logsdon, it was a serious calculation — and one that nearly killed her.

Logsdon, of Colorado Springs, drank only occasionally for most of her adult life, but around 2009, the stressors piled up and alcohol became a way of self-medicating her feelings of worthlessness, since she couldn’t afford health care. Having drinks after her daughter went to bed was a way to power through an unhealthy relationship and one terrible year where she went through a divorce, lost her job and had three loved ones die in as many months.

In early 2013, she decided to quit, but it was too late. About three weeks after her last drink, she woke up to find her skin was “bright yellow” and her abdomen was swollen with fluid. After only a few years of heavy drinking, she was experiencing liver failure — something she didn’t know was possible in such a short time.

“I was really ashamed for getting myself in this situation,” Logsdon said. “I felt like the doctors thought I was a loser.”

Logsdon’s experience has become more common in Colorado since the pandemic. Typically, a patient with liver failure from alcohol use is an older man with a long history of heavy drinking, but in recent years, more women and people under 40 are showing up in need of transplants, said Dr. James Burton, who takes care of patients before and after liver transplants at UCHealth in Aurora, but doesn’t perform the surgeries.

The youngest person he treated for alcohol-related liver failure was 23, he said. That patient’s kidneys also were failing, a combination that kills about 80% of people who have it within three months of diagnosis, according to the American Liver Foundation.

The demographics of patients needing liver transplants had started to shift even before 2020, but that change accelerated as people drank to cope with their stress, Burton said. That said, all gender and age groups saw increases in alcohol-related liver conditions over the last decade, he said.

“The pandemic poured gasoline on a fire,” he said.

Nationwide, the number of people added to the waiting list for a liver transplant because of an alcohol-related diagnosis rose from 4,087 in 2019 to 5,144 in 2021. Since then, alcohol-related listings have remained elevated, with 5,164 people listed in 2023.

Liver transplants also have increased in recent years, though not as fast as the rise in people joining the transplant list. In 2023, the United Network for Organ Sharing reported 10,659 liver transplants — a record, but not enough to help all of the 14,181 people added to the waiting list, let alone people who joined in previous years and were still alive and waiting.

The number of men listed for alcohol-related liver transplants increased 22% from 2019 to 2021, before decreasing marginally over the next two years. Women’s listings increased 35% in that time, and actually grew slightly in 2022 and 2023. Men were still twice as likely as women to need a liver for an alcohol-related diagnosis, though.

In Colorado, 783 people received new livers in 2023, which was also a record. As of Thursday, 163 people in Colorado were waiting for liver transplants, according to the United Network for Organ Sharing.

This comes as alcohol-related deaths in Colorado rose 60% from 2018 to 2021, before dropping slightly in 2022 — the subject of a four-part series published by The Denver Post earlier this month. Alcohol-associated liver disease is one of the biggest causes of that increase, killing 902 people in 2022.

People with whole lives ahead

Dr. Aram Neuschatz, a hospitalist at Lutheran Medical Center in Wheat Ridge, said he’s seen a similar pattern, and that the number of patients coming in with alcohol-related liver disease has continued to grow each year. In the last year, his youngest patient with liver disease related to drinking was 25.

“These are people who have whole lives, decades ahead of them,” he said.

Many of them are people who hold down jobs and take care of their children, so they never thought of their alcohol use as a problem until they developed jaundice, Neuschatz said. By that point, it may be too late to repair the damage, he said.

“What I’m really worried about are the people who have made a habit out of drinking every day or drinking six days out of seven or five days out of seven,” he said. “Those people are playing with fire.”

Usually, when people need a liver transplant, they have high levels of inflammation in the liver (also known as hepatitis), scarring (also known as cirrhosis), or both. Some people with alcohol-induced hepatitis get through the initial episode with steroid treatment to reduce inflammation, and their livers can recover if they stop drinking. Liver scarring won’t heal, though; the only option is to try to prevent more damage that could push someone to the end-stage of cirrhosis.

Burton estimated about 80% of the people that University of Colorado Hospital evaluated for liver transplants in the last year have conditions related to alcohol, as did about half of those who went on to receive a transplant. Some people evaluated aren’t eligible because they are too sick to receive the surgery or aren’t yet sick enough to immediately make the transplant list, and some die on the list while waiting for an organ. The hospital doesn’t require that patients be sober for a specific length of time, but evaluates how likely they are to return to heavy drinking on a case-by-case basis. he said.

The increase in alcohol-related liver disease follows a spike in liquor purchases early in the pandemic. A 2022 report in the Journal of Addiction Medicine found that from March to November 2020, Coloradans increased their purchases of spirits by about 17% and wine by about 10% compared to pre-pandemic trends, while buying slightly less beer than expected. (The data only included stores selling alcohol to drink at home, so it doesn’t account for changes in how much people bought from bars and restaurants.)

The trend may actually be more dramatic than it appears, because the drop in tourism during the pandemic means that permanent residents made a higher percentage of purchases, said Dr. Jarratt Pytell, an assistant professor at the University of Colorado School of Medicine, who wrote the report.

Researchers can’t prove that the increase in overall alcohol consumption and shift to drinking more spirits caused some of the increase in liver disease now, but it would make sense, Pytell said. People can develop health problems from drinking beer or wine, but the odds are higher with hard liquor because people don’t realize how quickly the small serving sizes add up, he said.

“It kind of looks like a duck, quacks like a duck,” he said.

Prevention is key

Drinking more during a highly stressful time isn’t ideal, but the bigger problem is that many people don’t return to their previous level of drinking once the immediate stressor is over, Pytell said. Studies after the Sept. 11, 2001, terror attacks and Hurricane Katrina found that most people who increased their alcohol use continued their higher level of drinking, though researchers weren’t set up to tell whether people developed alcohol addiction or just got into new habits, he said.

While patients who need a kidney can survive for a time on dialysis and some heart patients can use a device to keep their blood pumping until they get a transplant, no “bridge” treatment exists for people in liver failure. The liver filters the blood, produces substances needed for digestion, helps maintain blood sugar levels and regulates blood clotting, so if it fails, patients often have only weeks or months to live.

Blood tests can detect liver damage before it progresses too far to heal on its own, but since the early stages of damage don’t typically cause symptoms, patients who don’t have regular checkups wouldn’t know to ask for the tests.

While the Centers for Disease Control and Prevention recommend that men have no more than two drinks a day and women have no more than one, people respond differently to the same amount of alcohol, Burton said. About 10% of heavy drinkers develop liver disease, but no one can know which person it will be in a group of 10 people who drink large amounts, he said.

“You can’t compare how you drink to your friends” and assume you’ll be alright, he said.