Early liver transplantation for severe alcohol-associated hepatitis: A single-center experience

Abstract

Liver transplantation (LT) is life-saving for patients with alcohol-associated liver disease (ALD) and severe alcohol-associated hepatitis (SAH). In this retrospective analysis of deceased donor LT from 10/2018 to 4/2022, patients were subdivided into those with ALD with <6 months (M) or >6 M sobriety vs. non-ALD etiologies of liver disease. Patients with <6 M sobriety were further stratified into those meeting the NIAAA criteria for SAH. Of the 367 LT, ALD comprised 171(47 %) of all LT; 85(50 %) had <6 M sobriety. Comparing those with ALD with <6 M to >6 M sobriety and other non-ALD etiologies, those with <6 M were younger (mean age 46 vs. 54 and 56 years; p < .001), had higher MELD (36 vs. 26 and 23; p < .001), and on the list fewer days (14 vs. 83 and 168; p < .001) while there were no differences in gender or length of stay following LT. Of those with <6 M sobriety, 41 met the NIAAA definition of SAH: mean age 43, 42 % female, 0 % AA, mean MELD of 37, mean days of abstinence 58d prior to LT with 29 % prior ALD rehabilitation, 58 % failed steroids, and were listed for 7 days prior to LT. The 1-year survival was similar in all groups with 90 % in SAH, 93 % in <6 M, 93 % in >6 M, and 94 % in those receiving LT for all other causes. While 24 % with SAH had an alcohol slip following LT, only 4 % had a return to harmful drinking. Our single center experience shows LT for those with AUD and <6 M of sobriety and specifically SAH have excellent 1-yr survival similar to those with AUD >6 M sobriety and other etiologies with a low rate of return to harmful drinking.