Long-term outcomes of liver transplantation for alcohol-related liver disease

Abstract

Background: Liver transplantation (LT) is being increasingly performed for alcohol-related liver disease (ALD). It is unclear whether the increasing frequency of LTs in ALD patients has a negative impact on deceased-donor (DDLT) allocation and whether the current policy of 6 months of abstinence before transplantation effectively prevents recidivism after transplantation or improves long-term outcomes. Methods: A total of 506 adult LT recipients, including 97 ALD patients, were enrolled. The outcomes of ALD patients were compared with those of non-ALD patients. The 97 ALD patients were further divided into group A (6-month abstinence) and group N (nonabstinence) based on the pretransplant alcohol withdrawal period. The incidence of relapsed drinking and the long-term outcomes were compared between the two groups. Results: The prevalence of LT for ALD significantly increased after 2016 (27.0% vs 14.0%; p < 0.01), but the frequency of DDLT for ALD remained unchanged (22.6% vs 34.1%, p = 0.210). After a median follow-up of 56.9 months, patient survival was comparable between the ALD and non-ALD patients (1, 3, and 5 years posttransplant: 87.6%, 84.3%, and 79.5% vs 82.8%, 76.6%, and 72.2%, respectively; p = 0.396). The results were consistent irrespective of the transplant type and disease severity. In ALD patients, 22 of the 70 (31.4%) patients reported relapsed drinking after transplantation, and the prevalence in group A had a higher tendency than that in group N (38.3% vs 17.4%, p = 0.077). Six months of abstinence or nonabstinence did not result in a survival difference, and de novo malignancies were the leading cause of late patient death in ALD patients. Conclusion: LT achieves favorable outcomes for ALD patients. Six months of abstinence pretransplant did not predict the risk of recidivism after transplantation. The high incidence of de novo malignancies in these patients warrants a more comprehensive physical evaluation and better lifestyle modifications to improve long-term outcomes.

Outcomes of liver transplant in patients with alcohol use disorders and opioid use disorders

“…[3] In a 2023 study of 506 LT recipients (97 of whom had ALD), 1 year, 3 year, and 5 year survival rates posttransplant were also similar (87.7%/84.3%/79.5% for ALD group vs. 82.8%/76.6%/ 72.2% in the non-ALD group). [4] Studies have also shown that rates of adherence and rates of rejection are comparable between ALD and non-ALD groups. [5] The most common causes of death for patients who undergo ALD LT are de novo malignancies and cardiovascular disease; however, this may also be confounded by the high comorbidity of nicotine use disorder in these patients.…”

“…Reported rates of relapse on alcohol posttransplant were quite variable across studies. The percentage of any drinking posttransplant, ranged from 30% to 50% 4,7,8 . However, the percentage of patients who return to heavy drinking was less, ranging from 6% to 30% 8 .…”

“…[5] The most common causes of death for patients who undergo ALD LT are de novo malignancies and cardiovascular disease; however, this may also be confounded by the high comorbidity of nicotine use disorder in these patients. [3,4,6] In a study reviewing patients in the European Liver Transplant Registry,…”

“…The percentage of any drinking posttransplant, ranged from 30% to 50%. [4,7,8] However, the percentage of patients who return to heavy drinking was less, ranging from 6% to 30%. [8] Though these rates may cause some alarm, it is important to note that these are still substantially lower than the rate of relapse in the general population, which is typically 60%-80%.…”

“…[9] In a 2023 study, 6-month abstinence again did not predict rates of relapse on alcohol and did not impact survival. [4] An interesting area where the length of sobriety comes into question is LT for acute alcohol-associated hepatitis (AH). Unlike alcohol-induced cirrhosis, acute AH is a rapid-onset condition that occurs in the setting of active drinking, so it does not afford the ability to monitor for a longer period of sobriety.…”