Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse

Gastroenterology. 2021 Dec;161(6):1896-1906.e2. doi: 10.1053/j.gastro.2021.08.004. Epub 2021 Aug 8.

Abstract

Background & aims: In 2018, our team initiated a prospective pilot program to challenge the paradigm of the "6-month rule" of abstinence for patients with alcohol-related liver disease (ALD) requiring transplant. Our pilot involved an in-depth examination of patients' alcohol use, social support, and psychiatric comorbidity, as well as the provision of pre- and post-transplantation addiction treatment.

Methods: Patients with ALD were assessed for inclusion in the pilot by a multidisciplinary team. Relapse prevention therapy was provided directly to all patients deemed to meet the program's inclusion criteria. Random biomarker testing for alcohol was used pre and post transplantation.

Results: We received 703 referrals from May 1, 2018 to October 31, 2020. After fulfilling the program's criteria, 101 patients (14%) were listed for transplantation and 44 (6.2%) received transplants. There were no significant differences in survival rates between those receiving transplants through the pilot program compared with a control group with more than 6 months of abstinence (P = .07). Three patients returned to alcohol use during an average post-transplantation follow-up period of 339 days. In a multivariate analysis, younger age and lower Model for End-Stage Liver Disease scores at listing were associated with an increased likelihood of a return to alcohol use (P < .05); length of abstinence was not a predictor.

Conclusions: Our prospective program provided direct monitoring and relapse prevention treatment for patients with ALD and with less than 6 months of abstinence and resulted in a reduction of post-transplantation return to drinking. This pilot study provides a framework for the future of more equitable transplant care.

Keywords: 6 Months of Abstinence; Alcohol Use Disorder; Alcohol-Related Liver Disease; Biomarker Monitoring; Relapse Prevention Therapy.

MeSH terms

  • Alcohol Abstinence*
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / prevention & control*
  • Alcohol Drinking / psychology
  • Alcoholism / complications
  • Alcoholism / diagnosis
  • Alcoholism / psychology
  • Alcoholism / therapy*
  • Biomarkers / blood
  • Biomarkers / urine
  • Clinical Decision-Making
  • Clinical Enzyme Tests
  • Female
  • Glucuronates / urine
  • Humans
  • Liver Cirrhosis, Alcoholic / diagnosis
  • Liver Cirrhosis, Alcoholic / etiology
  • Liver Cirrhosis, Alcoholic / surgery*
  • Liver Function Tests
  • Liver Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Patient Selection
  • Pilot Projects
  • Predictive Value of Tests
  • Prospective Studies
  • Psychotherapy*
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Glucuronates
  • ethyl glucuronide