Alcohol and other substance use after liver transplant

Winder, Gerald Scott; Shenoy, Akhil; Dew, Mary Amanda; DiMartini, Andrea F.

doi:10.1016/j.bpg.2020.101685

Cited by 16 publications

(25 citation statements)

References 77 publications

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“… Alcohol relapses occur in varying trajectories after OLT (40)  Access to specialized AUD treatment and Rx is low in ALD patients (41,42)  Withdrawal can precipitate or complicate any medical clinic and hospital ALD patient presentation  ALD teams will need to decide whether BZD (which carry risks of abuse, cognitive and psychomotor side effects) are indicated for withdrawal or if other agents should be used (48)  Selection and follow-up of AUD Rx is optimal when psychiatric and medical professionals coordinate care given dosing adjustments in liver and kidney disease and OLT-related considerations (43) J o u r n a l P r e -p r o o f  Some AUD medications should not be used in liver disease while others must be carefully monitored given risks in end-stage disease and LT (43)  Many hepatologists do not feel comfortable prescribing AUD medications (44)  Shorter periods of pre-OLT sobriety (<6 months) have been shown to predict post-OLT drinking (45,46) but "6-month rules" are discouraged as numerous other factors should be considered (47)  ALD clinicians may understandably feel anger and resentment toward relapsing patients, sentiments which should be appropriately suppressed during clinical encounters and processed elsewhere if needed (11)  MI is an invaluable communication skillset (49) to mobilize ALD patients toward change behavior; ALD patients uniquely trust their liver clinicians (30)…”

Section: Alcohol Withdrawal and Aud Relapsesmentioning

confidence: 99%

Integrated Care of Alcohol-Related Liver Disease

Winder

Fernandez

Mellinger

2022

Journal of Clinical and Experimental Hepatology

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Section: Alcohol Withdrawal and Aud Relapsesmentioning

confidence: 99%

Integrated Care of Alcohol-Related Liver Disease

Winder

Fernandez

Mellinger

2022

Journal of Clinical and Experimental Hepatology

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“…Risk assessment of alcohol relapse is complicated by the lack of a standard definition of this entity with regard to either quantity or frequency of alcohol use. However, published data both in ALD and alcoholic hepatitis demonstrate that a significant proportion of transplant recipients resume alcohol use post-liver transplant with varying trajectories [8,9 ▪ ].…”

Section: Risk Of Allograft Dysfunction and Lossmentioning

confidence: 99%

Transplant in acute alcoholic hepatitis: a relative contraindication

Jakhete

Abutaleb

Shetty

2022

Current Opinion in Organ Transplantation

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Purpose of reviewThe aim of this review is to provide a critical analysis of liver transplantation for alcoholic hepatitis, with an emphasis on barriers to long-term success in current implementation strategies across the United States.Recent findingsAlcohol-associated liver disease is the most rapidly increasing indication for liver transplantation in the USA. Its most severe form, acute alcoholic hepatitis, has a rising incidence particularly in the young, and is associated with a high mortality risk. Although excellent outcomes following liver transplantation for alcoholic hepatitis can be achieved, several barriers limit its routine use. These constraints include risk of allograft dysfunction, the recognition of alcohol use disorder as a multisystem disease and ethical considerations.SummaryAlthough liver transplantation is an important option in a carefully selected group of candidates, it should not be considered the standard of care in this condition. Consistency, transparency and consensus are necessary to formulate and implement policy changes at the national level. Following liver transplantation, wraparound services are important for relapse prevention, and to ensure long-term success and survival in this challenging group of patients.

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“…[ 1,2,11 ] Pharmacological treatment (i.e., acamprosate, baclofen) should be considered as part of AUD treatment [ 1,2 ] alongside various psychotherapy paradigms. [ 14 ]…”

Section: Substance Usementioning

confidence: 99%