Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder

Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder

Background. Alcohol use disorder (AUD) incidence is increasing, and alcohol-associated liver disease is the leading indication for liver transplantation (LT) in the United States. Many centers have adopted “early LT” (ELT) for patients with <6 mo of abstinence. This study evaluates whether ELT ou...

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Main Authors: Andrea M. Meinders, MD, Ashton A. Connor, MD, PhD, John Ontiveros, LCSW, Ahmed Elaileh, MD, Khush Patel, MD, MS, Jason Todd, BS, MBA, Danika L. Nottage, BS, BMSc, Elizabeth W. Brombosz, PhD, Linda W. Moore, PhD, Caroline J. Simon, MD, Yee Lee Cheah, MD, Mark J. Hobeika, MD, Constance M. Mobley, MD, PhD, Ashish Saharia, MD, Tamneet Basra, MD, Sudha Kodali, MD, MSPH, David W. Victor, III, MD, Brian P. Lee, MD, Norah Terrault, MD, Xian C. Li, PhD, A. Osama Gaber, MD, R. Mark Ghobrial, MD, PhD
Format: Article
Language:English
Published: Wolters Kluwer 2025-04-01
Series:Transplantation Direct
Online Access:http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001776
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Summary:Background. Alcohol use disorder (AUD) incidence is increasing, and alcohol-associated liver disease is the leading indication for liver transplantation (LT) in the United States. Many centers have adopted “early LT” (ELT) for patients with <6 mo of abstinence. This study evaluates whether ELT outcomes in acutely ill recipients are equivalent to standard LT (SLT). Methods. We retrospectively analyzed LTs for alcohol-associated liver disease in patients with AUD at a single center between January 2019 and December 2021. Patients were categorized as ELT (<6 mo) or SLT (≥6 mo). Alcohol relapse was categorized as “abstinent,” “slip,” or “harmful,” with use defined by phosphatidylethanol or self-reported consumption. Outcomes were post-LT relapse, graft, and patient survival. Results. Of 183 patients (ELT: 99 [54.1%]; SLT: 84 [45.9%]), ELT recipients were younger, had higher model for end-stage liver disease scores, shorter waitlist times, and were more frequently in intensive care unit pre-LT. Multivariable analysis showed no association in time to post-LT relapse, graft, or patient survival. Intensive care unit status was associated with lower relapse risk (hazard ratio, 0.17; 95% confidence interval, 0.07-0.43; P < 0.001), whereas higher education levels were associated with higher risk (hazard ratio, 2.31; 95% confidence interval, 1.18-4.49; P = 0.014). Conclusions. Pre-LT alcohol abstinence duration does not significantly impact post-LT relapse or survival. ELT should be considered for acutely ill patients with AUD.
ISSN:2373-8731

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