Evaluation of early vs standard liver transplant for alcohol-associated liver disease

1. In a cohort of patients with alcoholic liver disease, adherence to a 6-month abstinence period prior to liver transplant was not associated with improved post-surgical outcomes.

Evidence Rating Level: 2 (Good)

Although alcohol-associated liver disease is a leading indication for liver transplant, patients are often denied access due to pre-transplantation abstinence requirements. This cohort study sought to evaluate survival outcomes of early versus standard liver transplants. Early liver transplant was defined as less than 180 days of alcohol abstinence prior to the surgery, while standard was defined as 180 days or more. The study included 163 participants (mean [SD] age at transplant, 52[10] years; 108 [66%] male). From this cohort, 88 (54%) participants underwent early liver transplant while 75 (46%) received standard liver transplant. There was no difference between the groups in term of age or sex. The median (IQR) days of abstinence for the early group was significantly lower than the standard group (66.5 [35.0-116.0] days vs. 481.0 [280.0-850.0] days; P<0.001). The outcomes measured in this study were patient, allograft, relapse-free and hazardous relapse-free survival for patients from both groups. The study found that the early and standard transplant groups had similar 1-year and 3-year survival rates (94.1% [95% CI, 86.3%-97.5%] vs. 95.9% [95% CI, 87.8%-98.7%]; P=0.60). The allograft survival rate at 3-years was also similar amongst the early and standard group (81.7% [95% CI, 69.4%-89.4%] vs 74.7% [95% CI, 59.2%-85.0%]; P = 0.42). Relapse-free survival and hazardous relapse-free survival did not show any significant differences between the two groups. Therefore, the study concluded that adherence to the 6-month abstinence rule is not associated with improved outcomes. However, this was one of the largest studies evaluating early versus standard liver transplants, and similar studies are needed to further validate the results.

Click to read the study in JAMA Surgery

Image: PD

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