Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 312
*Purpose: ACCELERATE-AH is a multicenter consortium studying early liver transplant (LT) for alcoholic hepatitis (AH). To inform surveillance and intervention strategies for post-LT alcohol use, we sought to identify pre-LT factors to predict early vs. later post-LT alcohol use, and if these patterns were associated with post-LT survival.
*Methods: In this multi-center longitudinal analysis, 11 US sites provided detailed pre-LT psychosocial, clinical, post-LT alcohol use, and survival data. Consecutive patients with clinically-diagnosed severe AH, no prior diagnosis of liver disease or AH, who received LT from 2006-2018, were included. Alcohol use post-LT was any evidence of alcohol use post-LT: by clinical interview, biochemical testing, including ethyl glucuronide (ETG) or phosphotidylethanol (PEth). Alcohol use was categorized by date of first drink post-LT: none, early (≤1 year post-LT), later (>1 year post-LT). To evaluate factors predicting early vs. later post-LT alcohol use, Cox regression was performed, with LT recipients with no post-LT alcohol use as reference group, and center clustering.
*Results: 140 LT recipients for AH survived to home discharge (69% male, median pre-LT abstinence 55 days, MELD-Na 39, Lille 0.79, 49% overt encephalopathy), with median post-LT follow-up of 2.5 years (IQR 1.5-4.4). Post-LT alcohol use was as follows: 91 (65%) none, 32 (23%) early use, 17 (12%) later use. The proportion with sustained alcohol use among early (11/32; 34%) vs. later (4/17; 24%) alcohol use was similar (p=0.43). Probability of any alcohol use post-LT at 1-, 3-, 5- years was 24% (95%CI: 18-32), 37% (95%CI: 29-46), 42% (95%CI: 33-53). In MV analysis, predictors of early alcohol use post-LT were younger age (HR 1.06, p<0.001) and overt encephalopathy at LT (HR 1.75, p=0.03), and of later alcohol use post-LT were female sex (HR 1.96, p=0.001), >10 drinks/day pre-hospitalization (HR 2.45, p=0.04) and prior failed rehab attempt (HR 2.12, p=0.007). After adjusting for MELD in separate bivariate models, both early (HR 6.36, p=0.001) and later (HR 2.27, p=0.09) alcohol use were associated with increased risk of post-LT death, though the association with later alcohol use did not reach statistical significance.
*Conclusions: Pre-LT factors associated with early versus later post-LT alcohol use are different, which may inform surveillance strategies for post-LT alcohol use. Early (vs. later) post-LT alcohol use appears to be more harmful as evidenced by the higher mortality risk. This highlights the first year post-LT as an especially important period to target interventions to prevent and treat alcohol use.
To cite this abstract in AMA style:Lee BP, Rinella M, Im G, Rice J, Fix O, Therapondos G, Han H, Victor D, Weinberg E, Hsu C, Voigt M, Maddur H, Eswaran S, Foley D, Ghobrial R, Dinges L, Dodge J, Mehta N, Lucey M, Terrault N. Patterns and Predictors of Alcohol Use after Early Liver Transplant for Alcoholic Hepatitis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/patterns-and-predictors-of-alcohol-use-after-early-liver-transplant-for-alcoholic-hepatitis/. Accessed January 17, 2021.
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