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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| 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 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850097868511117312 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Andrea M. Meinders, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8ef837299e524b64a24d0506cb8604db |
| institution | DOAJ |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-8ef837299e524b64a24d0506cb8604db2025-08-20T02:40:51ZengWolters KluwerTransplantation Direct2373-87312025-04-01114e177610.1097/TXD.0000000000001776202504000-00007Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use DisorderAndrea M. Meinders, MD0Ashton A. Connor, MD, PhD1John Ontiveros, LCSW2Ahmed Elaileh, MD3Khush Patel, MD, MS4Jason Todd, BS, MBA5Danika L. Nottage, BS, BMSc6Elizabeth W. Brombosz, PhD7Linda W. Moore, PhD8Caroline J. Simon, MD9Yee Lee Cheah, MD10Mark J. Hobeika, MD11Constance M. Mobley, MD, PhD12Ashish Saharia, MD13Tamneet Basra, MD14Sudha Kodali, MD, MSPH15David W. Victor, III, MD16Brian P. Lee, MD17Norah Terrault, MD18Xian C. Li, PhD19A. Osama Gaber, MD20R. Mark Ghobrial, MD, PhD211 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX.3 Houston Methodist Academic Institute, Houston, TX.3 Houston Methodist Academic Institute, Houston, TX.3 Houston Methodist Academic Institute, Houston, TX.2 J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX.3 Houston Methodist Academic Institute, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX.2 J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX.2 J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX.6 Division of Gastroenterology and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA.6 Division of Gastroenterology and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.1 Department of Surgery, Houston Methodist Hospital, Houston, TX.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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001776 |
| spellingShingle | 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 Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder Transplantation Direct |
| title | Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder |
| title_full | Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder |
| title_fullStr | Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder |
| title_full_unstemmed | Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder |
| title_short | Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients With Alcohol Use Disorder |
| title_sort | outcomes for early liver transplantation for alcohol associated liver disease in high acuity liver transplant recipients with alcohol use disorder |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001776 |
| work_keys_str_mv | AT andreammeindersmd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT ashtonaconnormdphd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT johnontiveroslcsw outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT ahmedelailehmd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT khushpatelmdms outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT jasontoddbsmba outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT danikalnottagebsbmsc outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT elizabethwbromboszphd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT lindawmoorephd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT carolinejsimonmd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT yeeleecheahmd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT markjhobeikamd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT constancemmobleymdphd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT ashishsahariamd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT tamneetbasramd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT sudhakodalimdmsph outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT davidwvictoriiimd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT brianpleemd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT norahterraultmd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT xiancliphd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT aosamagabermd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder AT rmarkghobrialmdphd outcomesforearlylivertransplantationforalcoholassociatedliverdiseaseinhighacuitylivertransplantrecipientswithalcoholusedisorder |