Heterogeneity in Center Practices in Liver Transplantation for Alcohol-Associated Liver Disease in the United States
1Division of Gastroenterology, Hepatology & Nutrition, University of Minnesota, Minneapolis, MN, 2Stanford University, Palo Alto, CA, 3Henry Ford Hospital, Detroit, MI, 4University of Colorado School of Medicine, Aurora, CO, 5Community Health Network, Indianapolis, IN, 6University of Chicago, Chicago, IL, 7Vanderbilt University, Nashville, TN, 8Indiana University, Indianapolis, IN
Meeting: 2022 American Transplant Congress
Abstract number: 422
Keywords: Alcohol, Liver transplantation, Psychiatric comorbidity, Psychosocial
Topic: Clinical Science » Liver » 55 - Liver: Recipient Selection
Session Information
Session Name: Recipient Selection
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 7, 2022
Session Time: 3:30pm-5:00pm
Presentation Time: 4:10pm-4:20pm
Location: Hynes Room 312
*Purpose: Alcohol-associated liver disease (ALD) is now the leading indication for liver transplantation (LT) in the United States (US), particularly since LT has emerged as a treatment option for severe alcohol-associated hepatitis (AAH). It is not clear how centers are managing the additional medical and psychosocial issues associated with ALD.
*Methods: We conducted a national web-based survey of medical directors of LT centers in the US to identify center-level details on peri-LT 1) management of alcohol use disorder (AUD), 2) alcohol-associated cirrhosis (AAC), and 3) severe AAH.
*Results: Of the 117 adult LT centers, 100 (86%) unique responses were collected representing all OPTN regions with 67% University-based. 71% of centers reported having transplant psychiatry available; 79% addiction medicine; 87% psychology; 60% inpatient and 67% outpatient rehabilitation/treatment programs (Table). For LT for AAC, 70% of responding centers reported no minimum sobriety requirement; 21% required at least 6 months of sobriety. 100% of centers used alcohol biomarkers to monitor sobriety before LT, while only 79% used biomarkers in the post-LT period. 74% of centers had a protocol for recurrent alcohol use before LT for patients with AAC, while only 47% of centers had a post-LT protocol. 85% of centers reported performing LT for severe AAH. 74 (87%) centers had a protocol for LT evaluation: 58 (78%) had implemented a protocol within the past 4 years and 16 (22%) within 0-1 years. 52 (70%) centers reported inclusion of a patient agreement for sobriety maintenance, and 62 (84%) centers arranged a post-LT treatment plan for AUD prior to LT. 74 (87%) centers used biomarkers to monitor for sobriety after LT for severe AAH, and 40 (47%) centers had a protocol for recurrent alcohol use, most often triggering a hepatology (90%) or social work visit (87.5%).
| Responses= 100/117 LT centers | |
| UNOS Regions represented | 100% |
| Center Volume (LT/yr) | n |
| 0-50 | 31 |
| 51-100 | 37 |
| >100 | 32 |
| LT volume/year for ALD | % |
| 0-25% | 18 |
| 26-50% | 59 |
| 51-75% | 20 |
| 76-100% | 3 |
| Minimum Sobriety Time Requirement for AAC? | 30% |
| Center Resources for AUD | % |
| Transplant Psychiatry | 71 |
| Addiction Medicine | 79 |
| Psychologist | 87 |
| Inpatient Treatment Program | 60 |
| Outpatient Treatment Program | 67 |
| Monitoring for ETOH use | % |
| pre-LT | |
| Biomarkers | 100% |
| Routine screening for ETOH use | 75.5% |
| Protocol for ETOH use | 74% |
| post-LT | % |
| Biomarkers | 79% |
| Routine screening for ETOH use | 69.6% |
| Protocol for ETOH use | 47% |
| LT for severe AAH | n= 85 |
| LT volume/year | % |
| 0-5 | 60% |
| 6-10 | 18% |
| >10 | 23% |
| Protocol for LT in severe AAH? | Y= 87% |
| First hepatic decompensation | 85.1% |
| SIPAT score | 60.8% |
| Pre-LT plan for treatment of AUD | 83.8% |
| Post-LT monitoring for ETOH use | % |
| Biomarkers | 87.0% |
| Routine screening for ETOH use | 58.1% |
| Protocol for ETOH use | 47.0% |
*Conclusions: Our findings highlight a change in center attitudes towards LT for ALD: the majority of centers now have no minimum sobriety requirement for LT for AAC and most centers perform LT for severe AAH. The heterogeneity of resources and practices in the care of patients with ALD indicate a need for standardization to promote quality and reduce disparities in this population.
To cite this abstract in AMA style:
Lim N, Kwong A, Jafri S, Jesse M, Kriss M, Nair K, Pillai A, Shingina A, Desai A. Heterogeneity in Center Practices in Liver Transplantation for Alcohol-Associated Liver Disease in the United States [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/heterogeneity-in-center-practices-in-liver-transplantation-for-alcohol-associated-liver-disease-in-the-united-states/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress