Transplant Hepatology — Specialty Profile

Exploratory, not prescriptive. This profile blends hard data (pay, match rates, burnout, demographics, each sourced and dated) with generalizations and synthesized opinion about culture and "who fits." It's here to help you get curious and go find out for yourself, not to tell you who to become. Numbers marked ⟳ verify change every year; check the linked source before you quote one. Last reviewed: 2026-08-04.

Also called: hepatology, liver transplant medicine, TH. A 12-month ACGME-accredited fellowship entered after a gastroenterology fellowship, or an integrated three-year pathway that covers both. Organ system: the liver, and the decision about who receives a new one.

Subspecialty fellowship of Gastroenterology, itself a subspecialty of Internal Medicine.

The 30-second version

Transplant hepatology is the specialty that decides who gets a liver, and it cannot fill its own training positions. In the 2023 AASLD match, 62% of transplant hepatology positions went unfilled, while the parent gastroenterology fellowship turned away roughly 38.5% of the applicants who preferred it. Projections put adult hepatology at a 35% provider shortage by 2033. The reason for that gap is not mysterious and the field discusses it openly: one additional year after gastroenterology leads to a consultative, largely academic practice, while the same additional year spent on advanced endoscopy leads to one of the highest-earning practices in internal medicine. Meanwhile the disease itself has been transformed twice in a decade, once by curing hepatitis C and once by alcohol and metabolic liver disease replacing it. The trade at the center: the most consequential decision-making in internal medicine, made by a workforce that is shrinking against demand.

Quick dashboard (details and sources below)


Training after med school	7 years traditional (3 IM + 3 GI + 1 TH), or 6 via the integrated pathway
Total from college start	~15 years traditional, ~14 via the integrated pathway
Training chain	Med school (4) → IM (3) → GI (3) → 12-month ACGME transplant hepatology → ABIM certificate
Competitiveness	Low, and falling. 62% of positions went unfilled in the 2023 AASLD match ⟳
Typical full-time pay	Below general GI. Parent GI runs ~$500,000–$540,000 employed, ~$600,000–$645,000 production ⟳
Pay vs. parent (general GI)	Below, because the practice is consultative rather than endoscopic ⟳
Lifestyle	Inpatient-heavy academic consultative practice, with transplant call ⟳
Burnout	No subspecialty figure; parent GI is 43.5% against a 41.9% all-physician average (AMA 2025), tied with cardiology at the foot of the nine specialties it names ⟳
% women	51.2% of the 43 transplant hepatology fellows (ACGME, AY2024-25); parent GI 40.6% of fellows ⟳
DO / IMG accessibility	Parent GI is open (~29% IMG, ~15% DO of matched fellows); the transplant fellowship's own 43 run 20.9% IMG and one DO ⟳

What they actually do

Cirrhosis and its complications are the daily substance. Ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome, managed in people whose physiology is failing in several directions at once. This is genuinely complex internal medicine, and it is the reason hepatologists describe themselves as internists who happen to have a liver focus.

Transplant evaluation and candidate selection is the work that distinguishes the field from general hepatology. The hepatologist assembles the medical, surgical, psychiatric, and social picture, presents it to a selection committee, and participates in a decision about whether a person is listed. Because organs are scarce, that decision determines who lives.

Waitlist management is the ongoing version of the same responsibility. MELD scores, exception points, the deterioration that moves someone up, and the deterioration that takes them off.

Post-transplant care runs for the rest of the patient's life. Immunosuppression and its complications, rejection, biliary strictures, recurrence of the original disease in the new liver, renal dysfunction, metabolic syndrome, and the malignancy risk that chronic immunosuppression carries.

Hepatocellular carcinoma sits across both halves: surveillance in cirrhotics, locoregional therapy with interventional radiology, and the transplant criteria that determine whether a tumor is within listing range.

The rest of the practice: autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, viral hepatitis B and C, acute liver failure, vascular disorders of the liver, living donor evaluation, and the growing population of metabolic dysfunction-associated steatotic liver disease.

Representative work: management of decompensated cirrhosis and portal hypertension · variceal bleeding, ascites, SBP, hepatic encephalopathy, and hepatorenal syndrome · liver transplant evaluation and selection committee participation · MELD-based waitlist management · post-transplant immunosuppression and rejection · hepatocellular carcinoma surveillance and transplant criteria · autoimmune and cholestatic liver disease · viral hepatitis · acute liver failure and emergency listing · living donor evaluation · TIPS candidacy · MASLD and alcohol-associated liver disease.¹

A day in the life: heavily inpatient and consultative. Rounds on decompensated cirrhotics and post-transplant patients, transplant evaluations in clinic, and selection committee meetings that are structured, multidisciplinary, and often difficult. Most transplant hepatologists perform far less endoscopy than a general gastroenterologist, and many do almost none, which is the single largest practical difference between the two careers.

On call: real. Acute liver failure, variceal bleeding, and organ offers happen at night, and an organ offer carries a decision window measured in hours.

The training path & time to completion

Two routes now exist, and the newer one exists because of the pipeline problem.

The traditional route: medical school (4 yrs) → internal medicine residency (3 yrs) → gastroenterology fellowship (3 yrs) → 12-month ACGME-accredited transplant hepatology fellowship → ABIM certification in transplant hepatology.²³

The integrated pathway, developed jointly by AASLD and ABIM, produces certification in both gastroenterology and transplant hepatology in three years rather than four: 24 months of gastroenterology of which 18 are full-time clinical, plus 12 months of clinical transplant hepatology.²³

The traditional route is the research route. AASLD describes it as suiting trainees pursuing academic careers, advanced degrees, or research, because the three-year gastroenterology fellowship leaves room for scholarly work.²
The integrated route is the clinical route, described as suited to a clinically focused hepatology career, with a shortened overall training duration as the stated advantage.²
Both are ACGME-accredited and both lead to ABIM certification.²³
It matches through AASLD's own program, separately from the NRMP.⁴ ⟳
Total from the start of college: about 15 years traditional, about 14 integrated.

Why the second pathway exists. A shortened route to the same certificate is a direct response to a training year that trainees were declining to take. Read against the fill rate below, the integrated pathway is the field's attempt to remove the cost that was deterring people.

How competitive is it?

This is one of the least competitive fellowships in internal medicine, and it sits directly downstream of one of the most competitive.

62% of transplant hepatology positions went unfilled in the 2023 AASLD match.⁵ ⟳
The parent fellowship is the opposite. Gastroenterology fills at roughly 99.5% with about 1.6 applicants per position, and roughly 38.5% of applicants who prefer GI go unmatched.⁶ ⟳
The shortage is projected to worsen, with estimates of a 35% shortfall in adult hepatology providers by 2033.⁵ ⟳
It is not alone. Advanced heart failure and transplant cardiology left 43.3% of positions unfilled in 2024 and general nephrology 34.2%, so this is a pattern across transplant and cognitive subspecialties rather than a liver-specific failure.⁵ ⟳

The honest read. Anyone who completes a gastroenterology fellowship can have this. The field's problem is that most of them choose otherwise, and the reason is in the compensation section.

Board: ABIM certification in transplant hepatology, via either pathway.³

Compensation — the robust version

This is the clearest example in the Sky of an extra training year that reduces expected income, and the field's recruitment numbers reflect it.

The parent anchor. General gastroenterology runs roughly $500,000–$540,000 in employed and broad surveys and $600,000–$645,000 in production and group surveys, with partners holding ambulatory surgery center equity at $700,000 to $1,000,000 and above.⁶ ⟳

The sibling comparison is the one that matters. Advanced endoscopy is also a one-year fellowship after gastroenterology, it carries no board certificate at all, and it leads to a practice earning roughly $650,000 to $1,000,000 and above.⁶ Transplant hepatology takes the same year, adds a genuine ABIM certificate, and leads to a consultative academic practice. ⟳

Why the gap exists. Gastroenterology's income is built on endoscopy volume and on facility fees captured through ambulatory surgery center ownership. Transplant hepatologists perform substantially less endoscopy than general gastroenterologists and many perform almost none, so the revenue engine of the parent specialty is largely absent from the practice.⁶ What replaces it is cognitive work, committee time, and inpatient management, which are poorly compensated relative to procedures under current payment structures.

What the field itself is paid. Aggregator estimates place transplant hepatology near $480,000, and general hepatology somewhat below general gastroenterology. These are job-board figures rather than survey data and should be treated with the usual suspicion, but their direction is consistent with the structural reasoning and with the fill rate. ⟳

One genuine offset. Transplant programs are required to have a designated transplant hepatologist, which gives the role institutional value beyond its billing, and medical directorship of a transplant program carries a stipend. In a field with a documented shortage, that is real negotiating leverage.

Limited-data caveat: no MGMA, Doximity, or Medscape line cleanly isolating transplant hepatology was located, and the positioning here is inference from the parent field's documented economics plus the fill rate. Benchmark against academic gastroenterology scales and ask directly about endoscopy expectations, directorship stipends, and call structure. ⟳

Lifestyle

Inpatient-weighted and busier than most internal medicine subspecialties, because decompensated cirrhosis is a hospital disease.
Call is genuinely disruptive. Organ offers arrive at any hour with a short decision window, and acute liver failure is a true emergency.
The practice is academic and tertiary, since transplant happens at transplant centers.
Clinic is longitudinal, with post-transplant patients followed for life.
Committee and administrative time is substantial, and much of it is unbillable.
Little or no endoscopy for many, which removes both the income and the procedural rhythm of the parent specialty.
Geographic flexibility is poor. The jobs are at the roughly 150 US liver transplant centers, and nowhere else.⁷ ⟳

Lifestyle rating: 2.5/5. Among the more demanding internal medicine subspecialties, with real call, sick inpatients, and a fixed job map.

Wellbeing — the part to take seriously

No transplant-hepatology-specific burnout figure was located. Inherit parent gastroenterology, which the AMA's 2025 Organizational Biopsy puts at 43.5% against a 41.9% all-physician average, tied with cardiology at the foot of the nine specialties it names as most burned out. Medscape's GI-specific reporting measures a different thing, the composite of burnout, depression, or both, and puts that at roughly 53%.⁶ ⟳

The allocation burden is the field's distinctive weight and it has few parallels in medicine. Livers are scarce, the waiting list is longer than the supply, and people die on it. A transplant hepatologist participates in deciding who is listed and who is not, using criteria that are partly medical and partly social, and then watches the consequences. Very few physicians ration a life-saving resource explicitly and by name.

The alcohol question sits on top of that and it is changing under the field's feet. Alcohol-associated liver disease is now the leading indication for liver transplant, and the traditional six-month sobriety requirement is being abandoned in favor of early transplant for selected patients with alcohol-associated hepatitis.⁸ That shift is evidence-based and it also means the field is actively renegotiating one of its hardest moral questions in real time, with individual patients in the balance.

Watching people die of a treatable disease for want of an organ is the recurring grief. It is not a failure of the medicine.

The counterweight is unusually strong. Liver transplantation takes a person who is dying and returns them to a normal life, and the hepatologist follows that arc from evaluation through decades of post-transplant care. Practitioners describe it as the most complete before-and-after in internal medicine.

The disease shift carries its own weight. Hepatitis C was cured, which was a genuine triumph, and the space it left has been filled by alcohol and metabolic disease, both of which arrive with stigma attached and neither of which has a comparable cure.

Who's in the field (demographics)

ACGME counts transplant hepatology separately, and the cohort is tiny: 43 active fellows across 70 programs in academic year 2024-25. One fellow moves any percentage here by more than two points, so read these as a snapshot of a small class rather than as a stable rate.

Women: 51.2% of transplant hepatology fellows, 22 of 43 (ACGME, Table C.21). The fellow class is majority-female, above parent gastroenterology's 40.6%, while the practicing GI and hepatology workforce still skews male.⁶ ⟳
IMG: 20.9% of transplant hepatology fellows trained at international medical schools, 9 of 43 (ACGME, Table C.15), below parent GI's ~29% of matched fellows rather than above it. Another 4.7%, two fellows, trained in Canada.⁶ ⟳
DO: 2.3%, which is one fellow of 43 (ACGME, Table C.15), against roughly 15% of matched GI fellows. At that cohort size it is a person rather than a rate, and a low DO share in a fellowship that leaves most of its seats empty is at least as consistent with few DOs applying as with a filter.⁶ ⟳
Underrepresented in medicine: no subspecialty figure. Alcohol-associated and metabolic liver disease both track socioeconomic disadvantage, and access to transplant evaluation is strongly patterned by insurance, geography, and the social support requirements built into selection criteria. ⟳
The workforce is projected to shrink against demand, with a 35% shortfall in adult hepatology providers estimated by 2033.⁵ ⟳

Culture, personality & the online stereotypes

Who gravitates here: gastroenterology fellows who found that they liked the medicine more than the endoscopy. The field draws people who want complex inpatient physiology, who are comfortable with ethical weight and committee decision-making, and who want a long relationship with patients through a dramatic arc. It is academic, multidisciplinary, and closely tied to transplant surgery. As always, plenty of people in the field do not fit any single mold.

The stereotypes. Community perception rather than fact, each with a kernel and an unfair edge:

"An extra year to make less money." Accurate, documented, and the field's central recruitment problem.
"The internists of GI." Meant as a jab and usually accepted as a compliment, since decompensated cirrhosis is as complex as general medicine gets.
"You are a gatekeeper." True, and the part practitioners find hardest to explain to people outside the field.
"Nobody scopes anymore." Substantially true for many transplant hepatologists, and a real consideration for anyone who enjoys procedures.

What people say online (synthesized and paraphrased, not quotes): across trainee and physician forums, transplant hepatology reads as the intellectually respected choice that people talk themselves out of on money. The dominant recurring theme is the direct comparison with advanced endoscopy: same extra year, opposite financial outcome. A second is the loss of endoscopy, discussed both as a relief and as a loss of leverage. A third is call, described as genuinely hard, with organ offers at night as the specific complaint. A fourth is the academic job map, described as narrow and concentrated at transplant centers. The tone is admiring of the work and blunt about the economics.

Voices from the field. Paraphrased from published sources, with links to the originals:

AASLD describes the traditional four-year route as suiting research and academic careers, and the integrated three-year pathway as suiting a clinically focused hepatology career with a shortened overall duration of training.²
The American Society of Transplantation Fellows Task Force reports that 62% of transplant hepatology positions were unfilled in the 2023 AASLD match, and cites projections of a 35% shortage in adult hepatology providers by 2033.⁵
A study of US liver transplantation across 2013 to 2022 documents alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease displacing hepatitis C as the dominant indications.⁹

Why people choose it / why people leave

Why choose it: the most complex inpatient physiology in internal medicine · a before-and-after arc few specialties can match · a genuine ABIM certificate · lifelong relationships with post-transplant patients · a documented workforce shortage, which is job security and negotiating leverage · a shortened integrated pathway that removes the extra year · multidisciplinary work with transplant surgery, interventional radiology, and psychiatry.

Why leave or avoid it: an extra year that lowers expected income relative to general GI and dramatically relative to advanced endoscopy · little or no endoscopy · demanding call including nighttime organ offers · a job map limited to transplant centers · the moral weight of selection and allocation · patients who die waiting · stigmatized diseases with no cure comparable to what hepatitis C received.

Best fit if: you liked the medicine in GI more than the scope · complex multi-organ physiology appeals · you can carry ethical weight without it corroding you · academic tertiary practice suits you · you want to be part of a field with more demand than supply.

Not for you if: you want gastroenterology's income · you love endoscopy · you need geographic freedom · rationing decisions would follow you home · you want a predictable outpatient practice.

The FLI angle — Transplant hepatology for first-gen, low-income & immigrant students

Where it fits FLI realities well:

The route in is unusually open for a procedural specialty's subspecialty. Gastroenterology is reached through internal medicine, the most DO- and IMG-friendly residency in American medicine, and roughly 29% of matched GI fellows are IMGs with about 15% DOs.⁶ The competitive step is the GI fellowship, and transplant hepatology after it is the least competitive step in the whole chain. One honest qualifier on the last leg: the transplant fellowship's own 43 fellows run 20.9% IMG and include a single DO, so the openness you are counting on lives in the residency and the GI fellowship rather than in this year.⁶
PSLF fits almost perfectly, because transplant centers are academic and nonprofit, and the training years count.
The shortage is your leverage. A field with 62% of positions unfilled and a projected 35% provider shortfall is one where a graduate negotiates from strength.⁵
The patients are frequently people the system has already failed. Alcohol-associated and metabolic liver disease concentrate among people with less money and less access, and selection criteria that weigh social support can disadvantage patients whose families are working three jobs. A physician who understands that from the inside changes how those conversations go.

Risks to name honestly:

This is one of the longest training chains in internal medicine, and the last year of it costs you money. Fifteen years from the start of college, and the final year leads to a practice paying below the one you were already qualified for.⁶ If you are carrying large debt or supporting family, model this explicitly, and look hard at the integrated three-year pathway, which exists precisely to remove that year.
The sibling comparison is stark and you should make it deliberately rather than by accident. Advanced endoscopy is the same extra year for a practice earning $650,000 to $1,000,000 and above.⁶ Choosing hepatology means choosing against that, knowingly.
Geography is fixed to transplant centers. If staying near family in a particular place matters, general gastroenterology preserves that and this does not.
The ethical load is real and it is not evenly distributed. Deciding who gets an organ, using criteria that include social support and sobriety, will put you in rooms where your own background makes the unfairness more visible. Some people find that clarifying and some find it corrosive.

Bottom line for FLI: one of the most open doors in medicine at every step after internal medicine, leading to a boarded subspecialty with a documented shortage and genuine bargaining power, at the cost of an extra year that pays negatively and a job map fixed to transplant centers. The integrated pathway changes that arithmetic substantially, and anyone weighing this field for financial reasons should start there.

Fun facts

The field cannot staff itself: 62% of transplant hepatology positions went unfilled in the 2023 AASLD match, while roughly 38.5% of applicants who wanted the parent gastroenterology fellowship went unmatched.⁵⁶
Two one-year fellowships branch off the same gastroenterology training. One has no board certificate and pays $650,000 to $1,000,000 and above. The other has an ABIM certificate and pays less than general GI.⁶
Curing hepatitis C emptied a large part of the transplant list. Among candidates without liver cancer, hepatitis C fell from 28% in 2013 to 4% in 2022.⁹
Alcohol filled the gap. In the same group, adult candidates without liver cancer, alcohol-associated liver disease rose from 23% in 2013 to 48% in 2022, making it the single most common indication in that cohort.⁹
The six-month sobriety rule, long treated as fixed, is being abandoned in favor of early transplant for selected patients with alcohol-associated hepatitis.⁸
A shortened three-year pathway to the same double certification was created jointly by AASLD and ABIM, which is a training system openly redesigning itself to stop losing candidates.²

Sources

Clinical scope. Composite of published US transplant hepatology fellowship curricula, which consistently cover decompensated cirrhosis and portal hypertension, transplant evaluation and selection, MELD-based waitlist management, post-transplant immunosuppression and rejection, hepatocellular carcinoma, autoimmune and cholestatic liver disease, viral hepatitis, acute liver failure, and living donor evaluation. University of Michigan (https://medschool.umich.edu/departments/internal-medicine/divisions/gastroenterology-hepatology/education/fellowships-training-programs/transplant-hepatology), UCSF (https://gastroenterology.ucsf.edu/transplant-hepatology-fellowship), and Johns Hopkins (https://www.hopkinsmedicine.org/gastroenterology-hepatology/education-training/transplant-hepatology-fellowship), accessed 2026. ↩
Training pathways. American Association for the Study of Liver Diseases, Hepatology Training Pathways — the traditional route is a three-year gastroenterology fellowship followed by one year of accredited transplant hepatology training, suited to trainees pursuing academic careers, advanced degrees, or research; the integrated dual-certification pathway completes both in three years total and is described as ideal for a clinically focused hepatology career with a shortened overall duration of training; both are ACGME-accredited and lead to ABIM certification. https://www.aasld.org/hepatology-training-pathways (accessed 2026). ⟳ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷
Certification requirements. American Board of Internal Medicine, transplant hepatology policies — dual certification in gastroenterology and transplant hepatology requires a minimum of three years of accredited combined training, of which 18 months must be clinical training in gastroenterology and 12 months clinical training in transplant hepatology. https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/transplant-hepatology/ (accessed 2026). See also the AASLD/ABIM pathway announcement, https://blog.abim.org/aasld-and-abim-announce-new-transplant-hepatology-training-pathway/. ⟳ ↩ ↩² ↩³ ↩⁴
Match mechanism. The transplant hepatology fellowship match is administered by AASLD through its own matching program rather than the NRMP. https://www.aasldapp.org/ (accessed 2026). ⟳ ↩
Fill rates and workforce projections. "Recommendations to overcome barriers to transplant fellowship training: A report from the American Society of Transplantation Fellows Task Force," American Journal of Transplantation — 62% of transplant hepatology positions were unfilled in the 2023 AASLD match; projections estimate a 35% shortage in adult hepatology providers by 2033; for comparison, 43.3% of advanced heart failure and transplant cardiology positions and 34.2% of general nephrology positions were unfilled in 2024. https://www.sciencedirect.com/science/article/abs/pii/S1600613525002618 (accessed 2026). ⟳ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷
Parent-field figures: gastroenterology compensation employed ~$500k–$540k, production/group ~$600k–$645k, partners with ASC equity $700k–$1M+, senior owners $2.5M+; the advanced/interventional endoscopy +1 fellowship is non-boarded and earns ~$650k–$1M+; GI fellowship fills ~99.5% at ~1.6 applicants per position with ~38.5% of GI-preferring applicants unmatched; burnout 43.5% against a 41.9% all-physician average on the AMA's 2025 survey (https://www.ama-assn.org/practice-management/physician-health/these-9-physician-specialties-report-highest-burnout-rates), with a separate GI-specific composite of ~53% (burnout, depression, or both), mid-table; women 40.6% of fellows; ~29% IMG and ~15% DO of matched GI fellows; GI is reached through internal medicine, the most DO/IMG-friendly residency. See the gastroenterology and advanced endoscopy profiles on this site for the full versions. Sources for the non-pay figures above: fellowship fill rate, positions and applicants, NRMP, Results and Data: Specialties Matching Service 2026 Appointment Year, February 2026, Table 1A, https://www.nrmp.org/wp-content/uploads/2026/02/SMS_Results_and_Data_Report2026.pdf , which is the primary table for the fill and applicant figures and for the DO and IMG shares of matched GI fellows. Women among fellows, ACGME, Data Resource Book, Academic Year 2024-2025, Table C.21, https://www.acgme.org/globalassets/pfassets/publicationsbooks/2024-2025_acgme_databook_document.pdf , which puts gastroenterology fellows at 40.6% women. Transplant hepatology has its own rows in the same book, twelve lines below gastroenterology's: Table C.21 gives 70 programs and 43 fellows, 22 of them women (51.2%), and Table C.15 gives 31 U.S. LCME graduates (72.1%), 9 international medical school (20.9%), 1 osteopathic (2.3%) and 2 Canadian (4.7%). Corrected 2026-08-17: this page said no transplant-hepatology demographic data was located and inherited gastroenterology for all three axes, at ~34% women, ~29% IMG and ~15% DO. All three move on the measured figures, and two move against what the page was arguing: the fellow class is majority-female, and its IMG and DO shares both run below the parent's rather than above, which is why the dashboard no longer calls the subspecialty "good by GI standards" on that axis. The footnote's own flag about the 34% is retired now that the body carries 40.6%. Internal medicine as the route in, NRMP, Results and Data: 2026 Main Residency Match, May 2026, Table 2, https://www.nrmp.org/wp-content/uploads/2026/05/Main_Match_Results_and_Data-2026.pdf : of 11,194 categorical IM positions offered, 95.2% filled, with IMGs taking 42.3% and DOs 18.5%. IM is the largest door in the Match for IMGs by a wide margin; on DO share, family medicine at 31.7%, emergency medicine at 37.9% and PM&R at 38.3% all run higher. Burnout, Medscape Physician Burnout & Depression Report 2024 (n=9,226, fielded July–October 2023), which is paywalled and is relayed here through Healthgrades Pro (https://resources.healthgrades.com/pro/the-most-and-least-burned-out-physicians-by-specialty) and Advisory Board (https://www.advisory.com/daily-briefing/2024/01/31/physician-burnout); that edition puts gastroenterology at 50% on burnout alone against an all-physician average of 49%, and the ~53% here counts burnout, depression, or both, which is a wider measure. ⟳ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴
The transplant-center count, sourced 2026-08-17. The page had asserted "roughly 150 US liver transplant centers" with no citation, and the whole geography argument rests on it. The nearest published count found: Punjala SR, Logan AJ, Subramanian J, et al., "Outcomes of Liver Transplantation From Hepatitis C Virus-positive DCD Donors and Its Utilization Among Centers in the United States," Transplantation 2024;109(1):186-195, doi 10.1097/TP.0000000000005174, https://pmc.ncbi.nlm.nih.gov/articles/PMC11627318/ — "A total of 146 transplant centers performed liver transplantation in the United States during this 5-y study period," a window running November 2016 to December 2021. That is a count of centers that performed a transplant rather than a count of OPTN-certified programs, and it is four years old, so "roughly 150" is the honest form of it. OPTN maintains the authoritative current directory. ↩
The sobriety requirement. American Association for the Study of Liver Diseases, Liver Fellow Network — "Why the 6-Month Sobriety Rule for Liver Transplantation Is Being Abandoned: Evolution in Alcohol-Associated Liver Disease Care." https://www.aasld.org/liver-fellow-network/core-series/why-series/why-6-month-sobriety-rule-liver-transplantation-being (accessed 2026). ⟳ ↩ ↩²
Changing indications for liver transplant. "The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease," PMID 38126928 — among candidates without hepatocellular carcinoma, chronic hepatitis C fell from 28% in 2013 to 4% in 2022, alcohol-associated liver disease rose from 23% to 48%, and NASH/MASH rose from 19% to 27%. Younossi ZM et al., Hepatology Communications 2023 Dec 22;8(1):e0352, https://pubmed.ncbi.nlm.nih.gov/38126928/ . The scope, because it governs every figure above: the study draws on the Scientific Registry of Transplant Recipients for 2013–2022 and covers 116,292 adult candidates who underwent liver transplant with a known etiology, and the percentages quoted here are the without-HCC subset. In the HCC cohort the same paper reports different figures — hepatitis C 60% to 27%, NASH/MASH 10% to 31%, alcohol-associated liver disease 9% to 24%. Corrected 2026-08-17: this footnote and a Fun-facts bullet both added "as of 2023 alcohol-associated liver disease accounted for 41.1% of liver transplant recipients and MASLD 20.3%," attributed to this paper. The paper has no 2023 and no all-recipients denominator; its terminal year is 2022 and its denominator is candidates without HCC. Set beside the 48%, the 41.1% also read as a trend when the two were different populations. The 2013–2022 series verifies exactly against the abstract and carries the bullet on its own, so the 2023 pair is removed rather than re-attributed; if it is wanted back it needs the SRTR or OPTN annual report it actually came from, with the denominator named. ⟳ ↩ ↩² ↩³

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