*Purpose: Alcohol-associated hepatitis (AH) is the fastest growing indication for liver transplantation (LT) in the U.S. While spontaneous recovery (SR) can occur in patients with AH leading to waitlist removal, data is lacking. This study aims to determine the variables associated with SR and long-term outcomes in patients with AH listed for LT.

*Methods: Data were collected from the UNOS Standard Transplant and Analysis file for adult LT candidates with AH from 2012 to 2021. SR was defined as survival at 90 days after listing for LT. Patients were separated into 2 groups: SR group and non-SR group.

*Results: Over nearly 10 years, there were 1108 patients with AH listed for LT, and SR was observed in 166 patients (15.0%). Patients in the SR group had significantly lower MELD scores (22.5 vs 36.7), less severe encephalopathy, and lower renal replacement therapy (RRT) (all p<0.01 in Table 1). Predictors for SR were evaluated using multivariable logistic regression model. MELD score [hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.21-1.28] and encephalopathy (HR 1.73, 95% CI 1.07-2.79 in grade 1 to 2, and HR 2.39, 95% CI 1.10-5.23 in grade 3 to 4) at listing were independently related to non-SR status. ROC analysis demonstrated an area under the curve (AUC) of 0.90. Predictive performance was similar when only MELD score was used, with AUC of 0.90. Using a MELD cut-off of 31, the sensitivity was 85.2% and specificity was 82.5% to predict non-SR status. Forty-two patients (25.0%) underwent LT after SR at a mean of 426 days, while 837 patients (88.9%) underwent LT quickly in the non-SR group (mean 9 days). Patient survival in Figure 1 demonstrates that 1- and 5-year patient survival of 91.8% and 79.3% in patients underwent LT without SR, and 94.7% and 86.6% in patients underwent LT after SR, respectively. MELD score during wait list time did not change in patients underwent LT after SR (21.3 vs 20.2, p=0.35), but MELD score significantly decreased in patients without LT after SR (16.8 vs 23.3, p<0.01).

*Conclusions: SR is associated with MELD <31 at listing for LT for AH. While AH may stabilize in some, one-quarter of waitlisted patients with SR eventually require LT, suggesting a need for continued close monitoring.

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