Background: For patients with alcoholic liver disease (ALD), many transplant programs and payers have a mandatory six-month sobriety interval prior to transplant eligibility. However, the utility of the six-month rule in predicting alcohol relapse post-transplant is controversial.

Methods: Using our transplant database, patients were identified that underwent liver transplant (LT) evaluation in the years 2012-2014. All patients evaluated received a detailed psychosocial and substance abuse risk assessment in determining LT candidacy. The database and electronic medical record were reviewed for details of the assessment and post-transplant outcomes, when applicable.

Results: 232 total patients with ALD underwent LT evaluation. On evaluation, 116 had less than 6 months of sobriety (73 selected for transplant listing, 43 not selected) and 116 had more than 6 months of sobriety (70 selected, 46 not selected). All patients with short-term sobriety failed medical therapy prior to LT consideration. 25 patients were evaluated and transplanted within 6 months of their last drink. 31 patients were evaluated prior to 6 months sobriety, but transplanted after at least 6 months sobriety. 45 patients were evaluated and transplanted after achieving 6 months sobriety. Patients with less than 6 months sobriety at transplant had a higher MELD score at evaluation and transplant and finding steatohepatitis in their explant. The alcohol relapse rate was similar in all three groups (20% vs 19% vs 20%, p=.99). There was shorter median follow-up time in the short term sobriety cohort (552 vs 882 vs 751 days, p=0.02). There were no graft failures due to alcohol. In univariate analysis, alcohol relapse post-transplant was associated with >10 drinks per day prior to quitting (p=0.03), previous failed treatment attempts (p=0.03), and alcohol use despite liver disease (p=0.04). Less than 6 months sobriety at transplant was not associated with relapse (p=0.91).

Conclusions: A six-month abstinence period did not predict alcohol relapse rates in a selected population with ALD undergoing LT. Approximately 20% of patients transplanted for ALD suffered a relapse to alcohol, regardless of pre-transplant sobriety interval.

CITATION INFORMATION: Wenzke K, Kelly S, Eickhoff J, Lucey M, Rice J. Multidisciplinary Psychosocial Liver Transplant Evaluation in Patients with Alcoholic Liver Disease – Moving Beyond the Six-Month Rule. Am J Transplant. 2017;17 (suppl 3).

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