Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis

Lee, Brian P.; Mehta, Neil; Platt, Laura; Gürakar, Ahmet; Rice, John P.; Lucey, Michael R.; Im, Gene Y.; Therapondos, George; Han, Hyosun; Victor, David W.; Fix, Oren K.; Dinges, Lisanne; Dronamraju, Deepti; Hsu, Christine; Voigt, Michael; Rinella, Mary E.; Maddur, Haripriya; Eswaran, Sheila; Hause, Jessica; Foley, David P.; Ghobrial, R. Mark; Dodge, Jennifer L.; Li, Zhiping; Terrault, Norah A.

doi:10.1053/j.gastro.2018.04.009

Cited by 291 publications

(377 citation statements)

References 33 publications

Supporting

Mentioning

338

Contrasting

Unclassified

Order By: Relevance

“…20 A notable increase in liver transplants for ALD, especially since 2014, coincides with the first US reports of early liver transplant for alcoholic hepatitis at national meetings. These reports have been published recently 12,15,16 with generally favorable results, which we hypothesize may further increase the application of early liver transplant for ALD. We acknowledge, however, that these are temporal associations only and the increase of ALD as an indication for liver transplant may be associated with other unknown or unmeasured factors.…”

Section: Discussionmentioning

confidence: 53%

“…Further, to evaluate the outcomes of early liver transplant for alcoholic hepatitis, patients with a listing or transplant diagnosis of hepatocellular carcinoma (HCC) were excluded because HCC is typically an exclusion criterion in policies concerning early liver transplant. 3,12,15,16 We then performed sensitivity analyses with HCV infection and HCC included. In the sensitivity analysis involving HCC, patients with a secondary listing diagnosis of alcoholic cirrhosis or alcoholic hepatitis were categorized as having ALD if the primary listing diagnosis was HCC.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States

et al. 2019

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Alcohol-associated liver disease (ALD) has emerged as the most common indication for liver transplant in the United States, but data on the reasons for this increase and long-term post-liver transplant outcomes among liver transplant recipients are sparse. OBJECTIVE To characterize trends and long-term outcomes of liver transplant for ALD in the United States between 2002 and 2016. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective, national cohort study used data from the United Network for Organ Sharing database to evaluate all liver transplants performed in the United States between January 1, 2002, and December 31, 2016. MAIN OUTCOMES AND MEASURES National and regional trends in liver transplant for ALD, with a sensitivity analysis with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) included, and early (≤90 days after liver transplant) and late (>90 days after liver transplant) patient and graft survival. RESULTS The cohort consisted of 32 913 patients, including 9438 with ALD and 23 475 without ALD (patients who had HCV infection and HCC indications were excluded). Median age of patients with ALD was 54 years (interquartile range, 47–60 years) and of patients without ALD was 54 years (interquartile range, 44–61 years). Patients with ALD (vs non-ALD) were more frequently male (7197 of 9438 [76.2%] vs 11767 of 23 475 [50.1%]; P < .001) and white (7544 [80.0%] vs 17 251 [73.5%]; P < .001). The proportion of liver transplants for ALD increased from 24.2% (433 of 1791) in 2002 to 27.2% (556 of 2044) in 2010 and 36.7% (1253 of 3419) in 2016. With HCV infection included, the proportions of liver transplant for ALD were 15.3% in 2002,18.6% in 2010, and 30.6% in 2016, representing a 100% increase in liver transplant for ALD, of which 48% was associated with a decrease in HCV infection as an indication for liver transplant. The magnitude of increase in ALD was regionally heterogeneous and associated with changes in patient characteristics suggestive of alcoholic hepatitis: decreasing age (χ2 = 36.5; P = .005) and increasing model for end-stage liver disease score (χ2 = 69.1; P < .001). Cumulative unadjusted 5-year posttransplant survival was 79% (95% CI, 78%−80%) for ALD vs 80% (95% CI, 79%−80%) for non-ALD; cumulative unadjusted 10-year posttransplant survival was 63% (95% CI, 61%−64%) for ALD vs 68% (95% CI, 67%−69%) for non-ALD (P = .006). In multivariable analysis, ALD was associated with increased risk of late death after liver transplant (adjusted hazard ratio, 1.11; 95% CI, 1.03–1.20; P = .006). CONCLUSIONS AND RELEVANCE The findings suggest that early liver transplant for alcoholic hepatitis may be leading to broader acceptance of ALD for liver transplant. Late survival among liver transplant recipients with ALD was inferior to that among recipients with non-ALD indications, suggesting a need for future studies to identify patient profiles associated with best outcomes. Regional differences suggest heterogeneity in policies toward liver transplant for AL...

show abstract

Section: Discussionmentioning

confidence: 53%

Section: Methodsmentioning

confidence: 99%

National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Efforts to confirm these findings have largely come from the United States . A multicenter retrospective American study has extended these observations to 147 patients with AH, median MELD score of 39, who underwent LT before 6 months of abstinence (median abstinence of 55 days) from 2006 through 2017 at 12 US centers . These patients had no prior diagnosis of liver disease or episodes of AH.…”

Section: Liver Transplantation For Aldmentioning

confidence: 98%

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

Self Cite

View full text Add to dashboard Cite

“…Alcohol‐associated liver disease (ALD) is implicated in 50% of liver‐related deaths, and it recently surpassed hepatitis C to become the most common indication for liver transplantation (LT) in the United States . Alcoholic hepatitis (AH), a subset of ALD characterized by acute onset of jaundice in the setting of excessive alcohol intake and associated with high short‐term mortality, is increasingly being considered as an indication for LT in highly selected patients . Early LT for severe AH is performed without a minimum sobriety period because 75%‐90% of these patients will not survive beyond 2 months from presentation .…”

mentioning

confidence: 99%

“…Alcoholic hepatitis (AH), a subset of ALD characterized by acute onset of jaundice in the setting of excessive alcohol intake and associated with high short‐term mortality, is increasingly being considered as an indication for LT in highly selected patients . Early LT for severe AH is performed without a minimum sobriety period because 75%‐90% of these patients will not survive beyond 2 months from presentation . However, this emerging indication for LT is controversial, particularly given the perceived risk of posttransplant alcohol relapse and the association of alcohol relapse with poor graft outcomes …”

mentioning

confidence: 99%

Underestimation of Liver Transplantation for Alcoholic Hepatitis in the National Transplant Database

Lee

Rice

et al. 2019

Liver Transpl

Self Cite

View full text Add to dashboard Cite

Alcohol‐associated liver disease (ALD) can be coded in United Network for Organ Sharing (UNOS) as either alcoholic cirrhosis or alcoholic hepatitis (AH), without having specific criteria to assign either diagnosis. In this multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE‐AH) study, we sought to assess the concordance of the clinician diagnosis of AH at liver transplantation (LT) listing versus UNOS data entry of AH as listing diagnosis. In a prior study, consecutive early LT recipients transplanted for AH between 2012 and 2017 were identified by chart review at 10 ACCELERATE‐AH sites. In this current study, these same LT recipients were identified in the UNOS database. The primary UNOS diagnostic code was evaluated for concordance with the chart‐review assignment of AH. In cases where the primary listing diagnosis in UNOS was not AH, we determined the reason for alternate classification. Among 124 ACCELERATE‐AH LT recipients with a chart‐review diagnosis of AH, only 43/124 (35%) had AH as listing diagnosis in UNOS; 80 (64%) were listed as alcoholic cirrhosis, and 1 (1%) as fulminant hepatic necrosis. Of the 81 patients missing AH as a UNOS listing diagnosis code, the reasons for alternate classification were 44 (54%) due to a lack of awareness of a separate diagnosis code for AH; 13 (16%) due to concomitant clinical diagnosis of AH and alcoholic cirrhosis in the chart; 12 (15%) due to clinical uncertainty regarding the diagnosis of AH versus acute decompensated alcoholic cirrhosis; and 12 (15%) due to a data entry error. In conclusion, in a large cohort of LT recipients with AH, only 35% were documented as such in UNOS. Increased education and awareness for those performing UNOS data entry, the establishment of specific criteria to define AH in the UNOS database, and the ability to document dates of alcohol use would allow future research on ALD to be more informative.

show abstract

Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis

Cited by 291 publications

References 33 publications

National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States

National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Underestimation of Liver Transplantation for Alcoholic Hepatitis in the National Transplant Database

Contact Info

Product

Resources

About