Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
A Franco-Belgian protocol showed that early liver transplant (LT) in severe alcoholic hepatitis (AH) could improve survival with low incidence of alcohol relapse (AR). Application of this controversial indication is growing despite unclear generalizability, and U.S. data is currently limited to small single-center experiences.
In this retrospective multi-center cohort, we included patients with severe AH as first presentation of liver disease who underwent LT prior to 6 months of abstinence. AR was characterized as a “slip” (any use, followed by sobriety), sustained AR (continued use), and separately assessed for harmful patterns (binge or frequent use).
97 patients from 11 centers underwent LT. The study population was 73% male, 83% Caucasian, 76% privately insured, with median abstinence time of 59 (IQR 37-85) days. Median LT MELD was 39. Probability of post-LT survival was 97%, 91%, and 86% at 1, 3, and 5 years, with median follow-up of 1.7 (IQR 0.7-2.9) years. 26 of 97 (28%) had AR: 14 had slips, and 12 had sustained AR, with median time to AR 134 (IQR 79-336) days post-LT. 22 of 97 (23%) had harmful drinking patterns post-LT. Probability of AR was 24%, 32%, 42% at 1, 3, and 5 years. 2 of 7 deaths were alcohol-related. In univariate analysis, lack of self-admission at hospitalization (OR = 4.3, p=0.005), lack of complete acceptance of diagnosis (OR = 3.6, p=0.01), history of alcohol-related legal issues (OR = 2.9, p=0.046), younger age (OR = 0.9, p=0.04), and lower pre-LT Hopkins Psychosocial Scale (HPSS) scores (OR = 0.7, p=0.001) were associated with AR.
In this multi-center retrospective cohort with carefully selected patients, early LT provided excellent short-term survival, with considerable incidence of AR. Objective criteria to predict AR may help to refine selection process and improve outcomes in this controversial use of a scarce resource.
CITATION INFORMATION: Lee B, Mehta N, Platt L, Im G, Therapondos G, Han H, Victor D, Dronamraju D, Hanouneh I, Voigt M, Rinella M, Eswaran S, Hause J, Hsu C, Dodge J, Li Z, Terrault N. U.S. Outcomes in Early Liver Transplantation for Alcoholic Hepatitis: Results from the American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH). Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Lee B, Mehta N, Platt L, Im G, Therapondos G, Han H, Victor D, Dronamraju D, Hanouneh I, Voigt M, Rinella M, Eswaran S, Hause J, Hsu C, Dodge J, Li Z, Terrault N. U.S. Outcomes in Early Liver Transplantation for Alcoholic Hepatitis: Results from the American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH). [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/u-s-outcomes-in-early-liver-transplantation-for-alcoholic-hepatitis-results-from-the-american-consortium-of-early-liver-transplantation-for-alcoholic-hepatitis-accelerate-ah/. Accessed January 17, 2021.
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