A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement

Pose, Elisa; Torrents, Abiguei; Reverter, Enric; Pérez-Campuzano, Valeria; Campos‐Varela, Isabel; Avitabile, Emma; Gratacós‐Ginès, Jordi; Castellote, José; Castells, L.; Colmenero, Jordi; Tort, Jaume; Ginès, Pere; Crespo, Gonzalo

doi:10.1016/j.jhep.2021.02.033

Cited by 36 publications

(35 citation statements)

References 34 publications

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“…[23][24][25] As a related issue, a recent European publication indicated that nearly 9% of waitlisted patients with ALD could be delisted because of clinical improvement. 6 An increased rate among women was believed to be explained by the known sex disparities in access to LT, permitting a longer period of observation to allow for recovery. In our study, only 3.3% of AH patients were delisted because of clinical improvement and overall time from listing to delisting was extremely short (median 10 d).…”

Section: Discussionmentioning

confidence: 99%

“…4 This partly stems from the need to rely predominantly on the psychosocial assessment with limited opportunity for longitudinal follow-up pre-LT, and ongoing challenges in predicting which candidates will ultimately improve with medical management alone. 6 Severe AH is also associated with significant liver dysfunction and renal failure, leading to a high Model for End-stage Liver Disease (MELD) score and prompt access to LT once listed. Nevertheless, early LT is believed to offer a survival benefit over delaying LT to achieve a period of sobriety, particularly among those with high MELD score.…”

Section: Introductionmentioning

confidence: 99%

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Rising Trend in Waitlisting for Alcoholic Hepatitis With More Favorable Outcomes Than Other High Model for End-stage Liver Disease in the Current Era

et al. 2022

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Background. In the appropriate candidate, liver transplantation (LT) is a viable treatment for alcoholic hepatitis (AH). We compared the waitlisting trends and outcomes of AH patients in the context of others with high Model for End-stage Liver Disease (MELD) score. Methods. LT listings for AH between January 1, 2008, and June 12, 2020 were identified in the United Network for Organ Sharing database. Temporal trends in listings for AH were assessed. Covariate adjusted competing risks models evaluated waitlist mortality and LT rates between AH candidates and others with listing native MELD ≥30. Results. Between 2008 and 2019, waitlist additions for AH increased 6.5-fold. Waiting time for AH candidates was short (median 10 d). Delisting for clinical improvement was infrequent in AH, albeit higher than MELD ≥30 patients (3.3% versus 0.8%; P < 0.001). Among 99 centers with ≥1 AH listing, AH patients accounted for 0.2%–18.2% of all alcohol-related listings and 0.6%–25.0% of those with native listing MELD ≥30. Overall listing volume was larger at these 99 centers than the 40 with no AH listings (P < 0.001). AH candidates in 2014–2020 experienced improved waitlist survival (adjusted subhazard ratio, 0.67; 95% confidence interval, 0.52-0.86; P = 0.002) and higher transplant rates (adjusted subhazard ratio, 1.14; 95% confidence interval, 1.04-1.25; P = 0.006) versus other MELD ≥30 candidates. Conclusions. There has been a rising trend in waitlisting patients with AH and high MELD score. Liver disease causes influence waitlist outcomes and those of AH candidates are more favorable. Further research and allocation adjustments may be needed to ensure equitable organ allocation, based on liver disease cause, for those on the LT waitlist.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rising Trend in Waitlisting for Alcoholic Hepatitis With More Favorable Outcomes Than Other High Model for End-stage Liver Disease in the Current Era

et al. 2022

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“…In a landmark study by Vorobioff et al, 16 persistent abstinence from alcohol was linked to a significant reduction in Child‐Pugh score, portal pressure and size of oesophageal varices in patients with alcohol‐related cirrhosis. Furthermore, studies have demonstrated that a significant number of patients listed for liver transplantation due to decompensated alcohol‐related cirrhosis can be delisted as a result of abstinence‐induced improvements 17–19 …”

Section: Introductionmentioning

confidence: 99%

Hepatic recompensation according to Baveno VII criteria is linked to a significant survival benefit in decompensated alcohol‐related cirrhosis

Hofer

Simbrunner

Hartl

et al. 2023

Liver International

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Background & AimsRemoving the primary aetiological factor in decompensated cirrhosis may lead to a restoration of hepatic function. In this study, we investigated the clinical implications of recompensation and the subsequent survival in patients with decompensated alcohol‐related cirrhosis.MethodsThe rate of recompensation was evaluated in patients with decompensated alcohol‐related cirrhosis and persistent alcohol abstinence undergoing a hepatic venous pressure gradient (HVPG) measurement. Recompensation was defined according to Baveno VII criteria as resolution of ascites and hepatic encephalopathy, absence of variceal bleeding and improvement in liver function.ResultsTwo hundred and four abstinent patients with decompensated alcohol‐related cirrhosis (age: 57.2 [IQR:50.1–63.7] years; 75.0% male; median MELD: 15 [IQR:11–19]) and a median HVPG of 20 (IQR:18–24) mmHg were included. During a median follow‐up of 24.4 (IQR:10.9–50.4) months, 37 patients (18.1%) achieved abstinence‐induced recompensation. Lower baseline HVPG, lower Child‐Pugh score, lower BMI, higher albumin and higher mean arterial pressure were linked to a higher probability of recompensation. After adjusting for age, disease severity, portal hypertension and systemic inflammation, achieving recompensation resulted in a significant and considerable reduction in liver‐related mortality (adjusted HR: 0.091 [95% CI: 0.012–0.677]; p = .019). Only 13 patients (6.4%) developed hepatocellular carcinoma, with a tendency towards a lower risk upon recompensation (HR: 0.398 [95% CI: 0.084–1.878]; p = .245), yet this finding did not reach statistical significance and requires further investigation.ConclusionsAlcohol abstinence led to recompensation in 18.1% of our cohort of HVPG‐characterised patients with decompensated alcohol‐related cirrhosis. Achieving hepatic recompensation resulted in a >90% risk reduction in liver‐related mortality.

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“…A recent Spanish study confirmed that compared to other etiologies the probability of being taken off the list due to improvement was more frequent in patients with alcohol-related cirrhosis. Approximately 9% of patients with alcohol-related decompensated cirrhosis were taken off the list due to improvement after being listed compared with less than 2% of patients listed for cholestatic diseases or NASH (21). It is not surprising that the patients with the lowest MELD score had a higher probability of being taken off the list for improvement than patients with a high MELD score.…”

Section: Which Candidates With Arld Should Be Considered For Lt?mentioning

confidence: 99%

Liver Transplantation in Alcohol-related Liver Disease and Alcohol-related Hepatitis

Wandji¹,

Ningarhari²,

Lassailly³

et al. 2023

Journal of Clinical and Experimental Hepatology

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A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement

Cited by 36 publications

References 34 publications

Rising Trend in Waitlisting for Alcoholic Hepatitis With More Favorable Outcomes Than Other High Model for End-stage Liver Disease in the Current Era

Rising Trend in Waitlisting for Alcoholic Hepatitis With More Favorable Outcomes Than Other High Model for End-stage Liver Disease in the Current Era

Hepatic recompensation according to Baveno VII criteria is linked to a significant survival benefit in decompensated alcohol‐related cirrhosis

Liver Transplantation in Alcohol-related Liver Disease and Alcohol-related Hepatitis

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