Liver Transplantation for Severe Alcoholic Hepatitis: Report of a Single Center Pilot Program

Sundaram, Vinay; Wu, Tiffany; Klein, Andrew S.; Noureddin, Mazen; Kim, I.K.; Todo, Tsuyoshi; Ayoub, Walid; Galloway, Christopher; Christianson, Annette; Nissen, Nicholas N.

doi:10.1016/j.transproceed.2018.08.057

Cited by 11 publications

(15 citation statements)

References 7 publications

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“…One small single‐center study including 18 patients with severe AH being considered for LT had 8 patients denied LT, of which 6 (75%) died. [ 9 ] The other studies that examined outcomes post‐LT in those with severe AH did not follow up those who were denied LT. In the present study, we aimed to define the rate and degree of recovery in patients who underwent evaluation but were denied early LT for severe AH and the morbidity and mortality of survivors.…”

Section: Introductionmentioning

confidence: 99%

Recovery and outcomes of patients denied early liver transplantation for severe alcohol‐associated hepatitis

et al. 2021

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Background and aims Liver transplantation (LT) in alcohol‐associated hepatitis (AH) remains controversial, in part because spontaneous recovery (SR) can occur. There is a paucity of data on SR in patients with severe AH who undergo LT evaluation. The purpose of this study was to determine factors associated with SR and survival in patients with severe AH who undergo LT evaluation. Approach and results This is a retrospective study of ALD patients with Model for End‐Stage Liver Disease (MELD) >25 and <90 days abstinence who underwent LT evaluation at a single center between 2012 and 2018. One hundred forty‐four patients (median age, 45.5 years; 68.1% male) were included. Forty‐nine (34%) underwent LT and 95 (66%) patients did not undergo LT, and of those, 34 (23.6%) experienced SR. Factors associated with recovery were younger age (OR, 0.92; p = 0.004), lower index international normalized ratio (INR; 0.31; p = 0.03), and lower peak MELD (OR, 0.83; p = 0.02). Only 7 patients (20.6%) achieved a compensated state with a MELD <15 and absence of therapy for ascites or HE. Survival was improved in patients who underwent early LT when compared to SR. Survival was impaired in SR following relapse to alcohol use when compared to SR patients who abstained and LT recipients. Among all 6‐month survivors of AH, alcohol use trended toward an association with mortality (HR, 2.05; p = 0.17), but only LT was associated with decreased mortality risk (HR, 0.20; p = 0.005). Conclusions SR from AH after LT evaluation is associated with age, index INR, and lower peak MELD. Most recovered patients continue to experience end‐stage complications. LT is the only factor associated with lower mortality.

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Section: Introductionmentioning

confidence: 99%

Recovery and outcomes of patients denied early liver transplantation for severe alcohol‐associated hepatitis

et al. 2021

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“…6 For this study we utilized previously studied, numerically scored, psychosocial tools used to help selection of liver transplantation candidates with lower risk of relapse. As the study population was focused on patients undergoing expedited transplant listing, tools that utilized extended abstinence as a variable, such as a recently developed tool that required follow up time to observe if the patient followed up with an intensive outpatient program (IOP) 11 were not utilized in this study.…”

Section: Discussionmentioning

confidence: 99%

“…These basic criteria have become standard protocol in further studies of patients presenting with AAH. 10,11…”

Section: Introductionmentioning

confidence: 99%

An Assessment of the Psychosocial Evaluation for Early Liver Transplantation in Patients With Acute Alcoholic Hepatitis in the Context of Alcohol Use Disorder, a Case-Control Study

Dienstag

Mohan

et al. 2022

Subst�Abuse

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Background: Severe acute alcoholic hepatitis (AAH) has an extremely poor prognosis with a high short term mortality rate. As a result, many centers, including our own, have allowed transplant patients to be listed for transplantation prior to achieving 6-months of sobriety. Several scoring systems, designed to target patients with a minimal period of sobriety, have been proposed to identify patients with alcohol use disorder (AUD), who would be predisposed to relapse after liver transplantation. We investigated whether these scoring systems corroborated the results of the non-structured selection criteria used by our center regarding decision to list for transplant. Methods: We conducted a retrospective case-control study of 11 patients who underwent early liver transplantation for AAH matched with 11 controls who were declined secondary to low insight into AUD. Blinded raters confirmed the severity of the diagnosis of DSM-5 and scored the patients on a variety of structured psychometric scales used to predict alcohol relapse. These included the High Risk for Alcohol Relapse Scale (HRAR), Stanford Integrated Psychosocial Assessment Tool (SIPAT), Alcohol Relapse Risk Assessment (ARRA), Hopkins Psychosocial Scale (HPSS), Michigan Alcoholism Prognosis Score (MAPS), Alcohol Use Disorders Identification Test -Consumption (AUDIT-C), and Sustained Alcohol Use Post-Liver Transplant (SALT) scales. All patients who underwent transplantation were followed for harmful and non-harmful drinking until the end of the study period. Results: The transplant recipients had significantly favorable MAPS, HRAR, SIPAT, ARRA, and HPSS scores with cutoffs that matched their previous research. The SALT and AUDIT-C scores were not predictive of our selection of patients for transplantation. Despite an expedited evaluation and no significant period of sobriety, our case cohort had a 30% relapse to harmful drinking after an average of 6.6 years (5-8.5 years) of follow-up. Discussion: Despite the rapid assessment and the short to no period of sobriety, the patient cohort demonstrated a 30% relapse to harmful drinking, consistent with the 20% to 30% relapse to drinking rate reported after liver transplantation for all forms of alcoholic liver disease. Average scores from MAPS, HRAR, SIPAT, ARRA, and HPSS corroborated our current stratification procedures, with lower mean risk scores found in the transplanted group. Conclusion: Patients with AUD and severe AAH who obtain new insight into their disease and posses other favorable psychosocial factors have low rates of AUD relapse post-liver-transplantation. The psychosocial selection criteria for patients with alcoholic hepatitis in our institution are consistent with 4 of the 5 scoring systems investigated in their prediction of sobriety post-transplant.

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“…Prior studies suggested that medical co-morbidites superceded addiction rehabilitation as the most common cause of LT denial (10). Few studies have been published delineating the reasons for denial specifically in patients with AH (7,(11)(12)(13). Our hypothesis is that patients are more likely denied for liver transplantation due to psychosocial factors than medical co-morbidities.…”

Section: Introductionmentioning

confidence: 93%

Barriers for Liver Transplant in Patients with Alcohol-Related Hepatitis

Choi

Benhammou

Yum

et al. 2022

Journal of Clinical and Experimental Hepatology

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Liver Transplantation for Severe Alcoholic Hepatitis: Report of a Single Center Pilot Program

Cited by 11 publications

References 7 publications

Recovery and outcomes of patients denied early liver transplantation for severe alcohol‐associated hepatitis

Recovery and outcomes of patients denied early liver transplantation for severe alcohol‐associated hepatitis

An Assessment of the Psychosocial Evaluation for Early Liver Transplantation in Patients With Acute Alcoholic Hepatitis in the Context of Alcohol Use Disorder, a Case-Control Study

Barriers for Liver Transplant in Patients with Alcohol-Related Hepatitis

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