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Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis.
Gastroenterology. 2018 08; 155(2):422-430.e1.G

Abstract

BACKGROUND & AIMS

The American Consortium of Early Liver Transplantation for Alcoholic Hepatitis comprises 12 centers from 8 United Network for Organ Sharing regions studying early liver transplantation (LT) (without mandated period of sobriety) for patients with severe alcoholic hepatitis (AH). We analyzed the outcomes of these patients.

METHODS

We performed a retrospective study of consecutive patients with a diagnosis of severe AH and no prior diagnosis of liver disease or episodes of AH, who underwent LT before 6 months of abstinence from 2006 through 2017 at 12 centers. We collected data on baseline characteristics, psychosocial profiles, level of alcohol consumption before LT, disease course and treatment, and outcomes of LT. The interval of alcohol abstinence was defined as the time between last drink and the date of LT. The primary outcomes were survival and alcohol use after LT, defined as slip or sustained.

RESULTS

Among 147 patients with AH who received liver transplants, the median duration of abstinence before LT was 55 days; 54% received corticosteroids for AH and the patients had a median Lille score of 0.82 and a median Sodium Model for End-Stage Liver Disease score of 39. Cumulative patient survival percentages after LT were 94% at 1 year (95% confidence interval [CI], 89%-97%) and 84% at 3 years (95% CI, 75%-90%). Following hospital discharge after LT, 72% were abstinent, 18% had slips, and 11% had sustained alcohol use. The cumulative incidence of any alcohol use was 25% at 1 year (95% CI, 18%-34%) and 34% at 3 years (95% CI, 25%-44%) after LT. The cumulative incidence of sustained alcohol use was 10% at 1 year (95% CI, 6%-18%) and 17% at 3 years (95% CI, 10%-27%) after LT. In multivariable analysis, only younger age was associated with alcohol following LT (P = .01). Sustained alcohol use after LT was associated with increased risk of death (hazard ratio, 4.59; P = .01).

CONCLUSIONS

In a retrospective analysis of 147 patients who underwent early LT (before 6 months of abstinence) for severe AH, we found that most patients survive for 1 year (94%) and 3 years (84%), similar to patients receiving liver transplants for other indications. Sustained alcohol use after LT was infrequent but associated with increased mortality. Our findings support the selective use of LT as a treatment for severe AH. Prospective studies are needed to optimize selection criteria, management of patients after LT, and long-term outcomes.

Authors+Show Affiliations

University of California, San Francisco, San Francisco, California.University of California, San Francisco, San Francisco, California.Johns Hopkins University, School of Medicine, Baltimore, Maryland.Johns Hopkins University, School of Medicine, Baltimore, Maryland.University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.Icahn School of Medicine at Mount Sinai, New York, New York.Ochsner Medical Center, Jefferson, Louisiana.Keck School of Medicine of University of Southern California, Los Angeles, California.Houston Methodist Hospital, Houston, Texas.Swedish Medical Center, Seattle, Washington.Swedish Medical Center, Seattle, Washington.University of Maryland, School of Medicine, Baltimore, Maryland.Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.University of Iowa, Carver College of Medicine, Iowa City, Iowa.Northwestern University, Feinberg School of Medicine, Chicago, Illinois.Northwestern University, Feinberg School of Medicine, Chicago, Illinois.Rush Medical College, Chicago, Illinois.Rush Medical College, Chicago, Illinois.University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.Houston Methodist Hospital, Houston, Texas.University of California, San Francisco, San Francisco, California.Johns Hopkins University, School of Medicine, Baltimore, Maryland. Electronic address: zhipingli@jhmi.edu.University of California, San Francisco, San Francisco, California. Electronic address: norah.terrault@ucsf.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29655837

Citation

Lee, Brian P., et al. "Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis." Gastroenterology, vol. 155, no. 2, 2018, pp. 422-430.e1.
Lee BP, Mehta N, Platt L, et al. Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis. Gastroenterology. 2018;155(2):422-430.e1.
Lee, B. P., Mehta, N., Platt, L., Gurakar, A., Rice, J. P., Lucey, M. R., Im, G. Y., Therapondos, G., Han, H., Victor, D. W., Fix, O. K., Dinges, L., Dronamraju, D., Hsu, C., Voigt, M. D., Rinella, M. E., Maddur, H., Eswaran, S., Hause, J., ... Terrault, N. A. (2018). Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis. Gastroenterology, 155(2), 422-e1. https://doi.org/10.1053/j.gastro.2018.04.009
Lee BP, et al. Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis. Gastroenterology. 2018;155(2):422-430.e1. PubMed PMID: 29655837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis. AU - Lee,Brian P, AU - Mehta,Neil, AU - Platt,Laura, AU - Gurakar,Ahmet, AU - Rice,John P, AU - Lucey,Michael R, AU - Im,Gene Y, AU - Therapondos,George, AU - Han,Hyosun, AU - Victor,David W, AU - Fix,Oren K, AU - Dinges,Lisanne, AU - Dronamraju,Deepti, AU - Hsu,Christine, AU - Voigt,Michael D, AU - Rinella,Mary E, AU - Maddur,Haripriya, AU - Eswaran,Sheila, AU - Hause,Jessica, AU - Foley,David, AU - Ghobrial,R Mark, AU - Dodge,Jennifer L, AU - Li,Zhiping, AU - Terrault,Norah A, Y1 - 2018/04/12/ PY - 2017/11/25/received PY - 2018/03/25/revised PY - 2018/04/08/accepted PY - 2018/4/16/pubmed PY - 2018/8/14/medline PY - 2018/4/16/entrez KW - 6 Months KW - ACCELERATE-AH KW - Recidivism KW - Relapse KW - UNOS SP - 422 EP - 430.e1 JF - Gastroenterology JO - Gastroenterology VL - 155 IS - 2 N2 - BACKGROUND & AIMS: The American Consortium of Early Liver Transplantation for Alcoholic Hepatitis comprises 12 centers from 8 United Network for Organ Sharing regions studying early liver transplantation (LT) (without mandated period of sobriety) for patients with severe alcoholic hepatitis (AH). We analyzed the outcomes of these patients. METHODS: We performed a retrospective study of consecutive patients with a diagnosis of severe AH and no prior diagnosis of liver disease or episodes of AH, who underwent LT before 6 months of abstinence from 2006 through 2017 at 12 centers. We collected data on baseline characteristics, psychosocial profiles, level of alcohol consumption before LT, disease course and treatment, and outcomes of LT. The interval of alcohol abstinence was defined as the time between last drink and the date of LT. The primary outcomes were survival and alcohol use after LT, defined as slip or sustained. RESULTS: Among 147 patients with AH who received liver transplants, the median duration of abstinence before LT was 55 days; 54% received corticosteroids for AH and the patients had a median Lille score of 0.82 and a median Sodium Model for End-Stage Liver Disease score of 39. Cumulative patient survival percentages after LT were 94% at 1 year (95% confidence interval [CI], 89%-97%) and 84% at 3 years (95% CI, 75%-90%). Following hospital discharge after LT, 72% were abstinent, 18% had slips, and 11% had sustained alcohol use. The cumulative incidence of any alcohol use was 25% at 1 year (95% CI, 18%-34%) and 34% at 3 years (95% CI, 25%-44%) after LT. The cumulative incidence of sustained alcohol use was 10% at 1 year (95% CI, 6%-18%) and 17% at 3 years (95% CI, 10%-27%) after LT. In multivariable analysis, only younger age was associated with alcohol following LT (P = .01). Sustained alcohol use after LT was associated with increased risk of death (hazard ratio, 4.59; P = .01). CONCLUSIONS: In a retrospective analysis of 147 patients who underwent early LT (before 6 months of abstinence) for severe AH, we found that most patients survive for 1 year (94%) and 3 years (84%), similar to patients receiving liver transplants for other indications. Sustained alcohol use after LT was infrequent but associated with increased mortality. Our findings support the selective use of LT as a treatment for severe AH. Prospective studies are needed to optimize selection criteria, management of patients after LT, and long-term outcomes. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/29655837/Outcomes_of_Early_Liver_Transplantation_for_Patients_With_Severe_Alcoholic_Hepatitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(18)30442-6 DB - PRIME DP - Unbound Medicine ER -