INTRODUCTION

The American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) is a multicenter cohort from 8 UNOS regions studying early liver transplant (LT) for alcoholic hepatitis (AH). We compared early and late post-LT mortality in AH vs. alcoholic cirrhosis (ALC).

METHODS

All alcohol-related LTs since first LT for AH at 12 ACCELERATE-AH sites were included. AH was clinically-diagnosed severe AH, no prior diagnosis of liver disease or AH, and LT before 6 months of abstinence. ALC was a UNOS listing diagnosis of alcoholic cirrhosis and not within the AH group. HCV, HCC, other liver diseases, re-LT were excluded. Site-specific and UNOS data were used. Graft failure and death were primary outcomes.

RESULTS

We included 822 LT recipients from 2006-2016: 123 AH and 699 ALC. Median follow-up was 2.0 years in AH and ALC. Only 28% of AH patients had the correct listing diagnosis of AH in UNOS. AH patients vs. ALC were younger (42 vs. 54, p<0.001), college educated (50% vs. 41%, p=0.005), and higher MELD (38 vs. 30, p<0.001). Cumulative unadjusted 3-yr survival (85% vs. 86%, p=0.47) was similar in AH vs. ALC. In MV analysis, AH as LT indication (HR 1.42, p=0.02), mechanical ventilation at LT (HR 2.00, p=0.02) and DRI (HR 1.96, p=0.002) were associated with increased risk of death. In those aged ≥50, AH vs. ALC was associated with increased risk of death ≤90 days post-LT (HR 4.07, p=0.003).

CONCLUSIONS

Misclassification of AH in UNOS is frequent, highlighting the challenge in using UNOS alone to study LT outcomes in AH. After adjusting for covariates influencing survival, AH as indication for LT had a 40% higher risk of post-LT death vs. ALC, which was most pronounced in age≥50 and ≤90 days post-LT. Mortality ≤90 days post-LT is unlikely related to alcohol use post-LT; further studies are essential to elucidate factors contributing to early post-LT mortality in AH.

CITATION INFORMATION: Lee B., Im G., Dodge J., Voigt M., Rice J., Lucey M., Foley D., Platt L., Gurakar A., Mehta N., Therapondos G., Han H., Victor D., Fix O., Dinges L., Dronamraju D., Hsu C., Rinella M., Maddur H., Eswaran S., Hause J., Ghobrial R., Li Z., Terrault N. Higher Early Post-Liver Transplant Mortality in Recipients with Severe Alcoholic Hepatitis versus Alcoholic Cirrhosis Am J Transplant. 2017;17 (suppl 3).

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