*Purpose: In Canada, 6 months of abstinence for those with alcohol-associated liver disease (ALD) is typically required prior to being listed for liver transplantation (LT).This policy disadvantages those who cannot survive this timeframe. The Ontario ALD Pilot Program was initiated in 2018 to provide access to LT for ALD patients through an in-depth examination of alcohol use history, social support and psychiatric comorbidity, as well as the provision of pre- and post-LT relapse prevention therapy.

*Methods: All referrals were triaged using pilot-specific inclusion criteria. Patients were assessed by a multidisciplinary team, including transplant hepatology, addiction psychiatry, social workers and a nurse practitioner. Random ethyl glucuronide (EtG) testing for alcohol and relapse prevention therapy was performed.

*Results: We reviewed 390 referrals from May 2018 to November 2019, with an average NaMELD of 22. From these, 124 referrals (32%) were declined upon initial triage (73 did not meet program criteria, 61 for other reasons). The remaining (n = 256) were assessed, including by the psychosocial team (Figure 1). Of this group, 84 (33%) did not meet ALD inclusion criteria for the following reasons: 81 had severe alcohol use disorder, 19 had a positive urine EtG, 11 had severe psychiatric comorbidity and 16 declined to participate in relapse prevention. Forty-eight patients (12%) were listed for transplantation with an average NaMELD of 26. Twenty-five (6.4%) were transplanted, four of whom died within first 4 weeks post transplant. After an average of 156.8 days post-discharge from hospital, two patients had returned to alcohol use as per positive EtG tests.

*Conclusions: The high volume of declined referrals based on history of alcohol use highlight the challenge of assessing ALD patients with less than 6 months abstinence. Based on this complexity, close monitoring of potential relapse post-transplant and the provision of appropriate therapy should be integral part of transplant follow up for these patients.

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