Approaching Alcohol Use Disorder After Liver Transplantation for Acute Alcoholic Hepatitis

Ting, Peng–Sheng; Gürakar, Ahmet; Wheatley, Jason; Chander, Geetanjali; Cameron, Andrew M.; Chen, Po Hung

doi:10.1016/j.cld.2021.03.008

Cited by 7 publications

(7 citation statements)

References 85 publications

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“…Proponents of the oft-cited Health Belief Model may contend that the threat of death by severe ALD can lead ELT recipients to internalize the perils of alcohol and achieve sustained avoidance 26 . Unfortunately, the effect may be fleeting without posttransplant pharmacotherapy for alcohol use disorder or counseling to help recipients develop critical skills in identifying and assuaging personal triggers for drinking 27 . Altogether, the diverse post-ELT relationships with self, others, work, and alcohol suggest that transplant centers must adopt flexible, individualized approaches to address each ELT recipient’s unique life challenges.…”

Section: Discussionmentioning

confidence: 99%

Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease

Chen

Sung

Punchhi

et al. 2023

Liver Transplantation

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Transplant centers conventionally require at least 6 months of alcohol abstinence before offering liver transplants for alcohol-associated liver disease. However, early liver transplant (ELT)—proceeding with a transplant when clinically necessary without first meeting the conventional requirement—is increasingly gaining attention. In our study, we qualitatively assessed ELT recipients’ perceived challenges and supports regarding alcohol-associated liver disease, transplant, and posttransplant survivorship. To diversify perspectives based on gender, race/ethnicity, age, time since ELT, and pretransplant abstinence duration, we purposively recruited ELT recipients and conducted semistructured interviews. Recruitment continued until data saturation. We analyzed transcripts using inductive thematic analysis. We interviewed 20 ELT recipients between June and December 2020 and identified themes within 3 participant-characterized time periods. Three themes emerged in life before severe illness: (1) alcohol as a “constant” part of life, (2) alcohol use negatively affecting relationships and work life, and (3) feeling “stuck” in the cycle of drinking. Two themes emerged during the severe illness period: (4) rapidity of health decline and (5) navigating medical care and the 6-month abstinence requirement. Finally, in life after transplant, 4 themes emerged: (6) feelings of shame or stigma and new self-worth, (7) reconnecting with others and redefining boundaries, (8) transplant as a defining point for sobriety, and (9) work-related challenges. Overall, participants expressed gratitude for receiving a gift of life and acknowledged their responsibilities to the new liver. ELT recipient experiences reveal complex psychosocial challenges related to addiction, inadequate support system, and stigma, particularly in the posttransplant period. The care of ELT recipients would be incomplete if focused solely on optimizing patient or graft survival.

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Section: Discussionmentioning

confidence: 99%

Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease

Chen

Sung

Punchhi

et al. 2023

Liver Transplantation

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“…To date, few studies have evaluated the safety or efficacy of most agents for treating AUD in patients with ALD [86]. There are even fewer studies in transplant recipients [81,83,84]. Higher score associated with lower risk for relapse In one study, did not distinguish relapse [70].…”

Section: Treatment After Liver Transplantmentioning

confidence: 95%

“…Although these models may aid in the assessment of risk of alcohol relapse and can guide patient selection for transplant, there is no consensus on their use. Additional research and discussion needed to determine their role in conjunction with professional assessments by specialists for patient selection for liver transplantation [72 ▪ ,80 ▪ ,81,82].…”

Section: Alcohol Use Disordermentioning

confidence: 99%

“…To date, few studies have evaluated the safety or efficacy of most agents for treating AUD in patients with ALD [86]. There are even fewer studies in transplant recipients [81,83,84]. Three medications are currently approved by the US Food and Drug Administration (FDA) for the treatment of AUD: naltrexone, acamprosate, and disulfiram.…”

Section: Alcohol Use Disordermentioning

confidence: 99%

“…Three medications are currently approved by the US Food and Drug Administration (FDA) for the treatment of AUD: naltrexone, acamprosate, and disulfiram. All have been shown to reduce alcohol consumption and rates of relapse with a number needed to treat of 12–20 to prevent return to heavy alcohol use [81,86–89]. Several other medications have also shown promising results for treating AUD, including gabapentin, baclofen, topiramate, ondansetron, and varenicline, but are not yet Food and drug Administration (FDA) approved specifically for this indication [81,86–89].…”

Section: Alcohol Use Disordermentioning

confidence: 99%

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Liver transplantation for alcohol-associated hepatitis

Durkin¹,

Bittermann

2022

Current Opinion in Organ Transplantation

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Purpose of reviewEarly liver transplantation is emerging as a treatment option for severe alcohol-associated hepatitis refractory to pharmacotherapies. This review outlines the current status of transplantation for alcoholassociated hepatitis and the treatment of alcohol use disorder after liver transplantation. Recent findingsRates of early liver transplantation for alcohol-associated hepatitis are increasing with significant heterogeneity in practices across the Unites States. Recent studies have demonstrated a substantial survival benefit in patients transplanted for alcohol-associated hepatitis with improved outcomes in early vs. late transplantation, first vs. prior hepatic decompensation, and posttransplant abstinence/delayed relapse vs. early return to alcohol use. Several prediction algorithms have been developed to ascertain patients risk of alcohol relapse and aid in candidate selection, though data on treatment of alcohol use disorders in transplant recipients remains limited. SummaryAlthough controversial, early liver transplantation for severe alcohol-associated hepatitis has shown to be a lifesaving intervention. Additional research is needed to evaluate its long-term outcomes, optimize candidate selection, and understand treatment of alcohol use disorder posttransplant.

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