Aim: Prior studies have demonstrated liver transplantation (LT) as a viable option for patients with severe alcoholic hepatitis (AH) who fail steroid treatment. These studies employed early listing for LT after steroid failure, with a median time from failure to listing ranging from 9-16 days. Our center has considered LT for such patients, though the time to listing has been variable to allow for demonstration of outpatient sobriety in selected cases. Our aims were to evaluate post-transplant outcomes and relapse rates after LT for severe AH, and to compare survival between those listed for LT during their initial hospitalization versus those listed after a period of outpatient monitoring.

Methods: We retrospectively reviewed records of patients evaluated for LT at a single center with severe AH who were non-responders to steroids or were not appropriate steroid candidates, from 1/1/2015 to 9/22/2017. Non-response to steroids was determined based on the Lille score.

Results: 18 patients with severe AH who either failed or were not appropriate candidates for steroid treatment were evaluated for LT, of which 10 were listed for transplantation. Median MELD score at listing was 35 (range 24-40). Among these patients, 9 received LT and one had improvement in liver dysfunction. Median time from presentation with AH to listing was 76 days (range 17-132 days.) Among those listed for LT, 8 of 10 patients (78%) were discharged home after initial presentation for AH. All 8 patients patients demonstrated outpatient sobriety, and 4 were able to demonstrate outpatient sobriety greater than 30 days, while the remainder had subsequent readmission within 30-days after discharge. Post-transplantation, all 9 patients receiving LT remain alive with 1/9 (8%) having relapsed. All patients have excellent graft function. Of the 8 patients denied for listing, 2 recovered spontaneously, while 6 died (75%). Median time from presentation to death was 88 days (range 23-183 days).

Conclusions: Our data supports excellent post-transplant survival for patients with severe AH. Carefully selected patients may be discharged after initial presentation to demonstrate outpatient sobriety and to clarify other psychosocial issues before listing.

CITATION INFORMATION: Wu T., Nissen N., Galloway C., Klein A., Tran T., Ayoub W., Noureddin M., Kim I., Todo T., Sundaram V. Liver Transplantation for Severe Alcoholic Hepatitis: Is Early Always Necessary? Am J Transplant. 2017;17 (suppl 3).

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