Multicentered study of patient outcomes after declined for early liver transplantation in severe alcohol-associated hepatitis

Hsu, Christine; Dodge, Jennifer L.; Weinberg, Ethan M.; Im, Gene Y.; Ko, Jimin; Davis, William D.; Rutledge, Stephanie; Dukewich, Matthew; Shoreibah, Mohamed; Aryan, Mahmoud; Vosooghi, Aidan; Lucey, Michael R.; Rice, John P.; Terrault, Norah A.; Lee, Brian P.

doi:10.1097/hep.0000000000000267

Cited by 8 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, our study provides a ‘real world’ estimate of prognosis in hospitalized patients with mAH. Similarly, in sAH patients, we found a 90‐day mortality rate of 38% which is in line with other US‐based sAH studies 24,25 …”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Gaurnizo‐Ortiz,

Nephew,

Vilar‐Gomez

et al. 2023

Liver International

View full text Add to dashboard Cite

Background and AimsLittle is known about the clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis (mAH) as compared to severe alcohol‐associated hepatitis (sAH). Therefore, we aimed to describe the clinical characteristics and risk factors associated with mortality in hospitalized mAH patients.MethodsPatients hospitalized with alcohol‐associated hepatitis (AH) from 1 January 2010 to 31 December 2020 at a large US healthcare system [11 hospitals, one liver transplant centre] were retrospectively analysed for outcomes. Primary outcome was 90‐day mortality. AH and mAH were defined according to NIAAA Alcoholic Hepatitis Consortia and Model for End‐stage Liver Disease Score ≤ 20 respectively. Multivariable Cox regression analysis was performed to identify independent risk factors associated with 90‐day mortality.Results1504 AH patients were hospitalized during the study period, of whom 39% (n = 590) had mAH. Compared to sAH patients, mAH patients were older (50 vs. 48 years, p < 0.001) and less likely to have underlying cirrhosis (74% vs. 83%, p < 0.001). There were no differences between the two groups for median alcohol intake g/day (mAH 140.0 vs. sAH 112.0, p = 0.071). The cumulative proportion surviving at 90 days was 88% in mAH versus 62% in sAH (p < 0.001). On multivariable analysis, older age [HR 1.03 (95% CI 1.00–1.06), p = 0.020], corticosteroid use [HR 1.80 (95% CI 1.06–3.06), p = 0.030] and acute kidney injury (AKI) [HR 2.43 (95% CI 1.33–4.47), p = 0.004] were independently associated with 90‐day mortality.ConclusionsmAH carries a 12% mortality rate at 90 days. Age, AKI and corticosteroid use were associated with an increased risk for 90‐day mortality. Avoidance of corticosteroids and strategies to reduce the risk of AKI could improve outcomes in mAH patients.

show abstract

Section: Discussionsupporting

confidence: 92%

“…Hence, our study provides a 'real world' estimate of prognosis in hospitalized patients with mAH. Similarly, in sAH patients, we found a 90-day mortality rate of 38% which is in line with other US-based sAH studies 24,25. Identifying modifiable risk factors associated with mortality risk is crucial to improving outcomes in AH.…”

supporting

confidence: 90%

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Gaurnizo‐Ortiz,

Nephew,

Vilar‐Gomez

et al. 2023

Liver International

View full text Add to dashboard Cite

show abstract

“…All patients had MELD scores greater than 20 and had abstained from alcohol for less than 6 months. 67 The results demonstrated a low overall probability (10%) of 1-year recompensation. Among the patients who were declined for LT due to clinical improvement, the probability of 1-year recompensation was 28%.…”

Section: Outcome S Of E Arly Liver Tr Ans Pl Antation and Controver S...mentioning

confidence: 85%

“…The study included randomly selected patients who were evaluated for LT for severe AH, but ultimately declined because of clinical improvement. All patients had MELD scores greater than 20 and had abstained from alcohol for less than 6 months 67 . The results demonstrated a low overall probability (10%) of 1‐year recompensation.…”

Section: Outcomes Of Early Liver Transplantation and Controversiesmentioning

confidence: 92%

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

Ramirez‐Cadiz,

Blaney,

Kubanek

et al. 2024

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundAlcohol‐associated hepatitis (AH) is a severe inflammatory form of alcohol‐associated liver disease (ALD) that carries a high mortality rate. Early liver transplantation for severe AH is increasingly available. However, specific criteria for referral and selection remain a subject of debate.AimsTo provide a narrative review of the natural history, diagnostic criteria and indications for referral for early liver transplantation for severe AH.MethodsWe searched PubMed for articles published through August 2023. Key search terms were ‘alcoholic hepatitis,’ ‘alcohol‐associated hepatitis,’ ‘abstinence,’ ‘alcohol relapse,’ and ‘liver transplantation.’ResultsPreviously, a six‐month period of alcohol abstinence was required before patients with ALD were considered for liver transplantation. However, studies in recent years have demonstrated that, among carefully selected patients, patients who received early transplants have much higher survival rates than patients with similarly severe disease who did not undergo transplants (77% vs. 23%). Despite these successes, early liver transplantation remains controversial, as these patients have typically not undergone treatment for alcohol use disorder, with the ensuing risk of returning to alcohol use.ConclusionsWhile early liver transplantation for AH has survival benefits, many patients would not have received treatment for alcohol use disorder. An integrated approach to evaluating candidacy for early liver transplantation is needed.

show abstract

“…This catastrophic SAH population constituted 38% of our entire cohort. Furthermore, studies have demonstrated that liver recompensation is infrequent among SAH patients declined for LT, 16 highlighting the need for urgent decision‐making regarding LT candidacy (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Expedited liver transplantation as first‐line therapy for severe alcohol hepatitis: ELFSAH; deferring corticosteroids in the sickest subset of patients

Mohy‐ud‐din,

Lin,

Rachakonda

et al. 2024

Clinical Transplantation

View full text Add to dashboard Cite

Background & aimsSevere alcohol‐associated hepatitis (SAH) represents a lethal subset of alcohol‐associated liver disease. Although corticosteroids are recommended by guidelines, their efficacy and safety remain questionable and so liver transplantation (LT) has been increasingly utilized. The timing and indication of corticosteroid use, specifically in patients being considered for LT requires further clarification.MethodsA retrospective analysis was conducted on 256 patients with SAH between 2018 and 2022 at a single US center.ResultsTwenty of these patients underwent LT. Of the 256 patients, 38% had what we termed “catastrophic” SAH, defined as a MELD‐Na ≥35 and/or discriminant function (DF) ≥100, which carried a mortality of 90% without LT. Compared with 100 matched controls, patients undergoing LT exhibited a one‐year survival rate of 100% versus 35% (p < .0005). LT provided an absolute risk reduction of 65%, with a number needed to treat of 1.5. Steroid utilization in the entire cohort was 19% with 60% developing severe complications. Patients administered steroids were younger with lower MELD and DF scores. Only 10% of those prescribed steroids derived a favorable response. Sustained alcohol use post‐LT was 20%.ConclusionsWe propose ELFSAH: Expedited LT as First Line Therapy for SAH; challenging the current paradigm with recommendations to defer steroids in patients with “catastrophic” SAH (defined as: MELD‐Na ≥35 and/or DF ≥100). Patients should be seen urgently by hepatology, transplant surgery, psychiatry and social work. Patients without an absolute contraindication should be referred for LT as first‐line therapy during their index admission.

show abstract

Multicentered study of patient outcomes after declined for early liver transplantation in severe alcohol-associated hepatitis

Cited by 8 publications

References 21 publications

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

Expedited liver transplantation as first‐line therapy for severe alcohol hepatitis: ELFSAH; deferring corticosteroids in the sickest subset of patients

Contact Info

Product

Resources

About