Post-transplant Outcomes of Persons Receiving a Liver Graft for Alcoholic Liver Disease

Rogal, Shari S.; Shenai, Neeta; Kruckenberg, Katherine M.; Rosenberger, Emily M.; Dew, Mary Amanda; DiMartini, Andrea F.

doi:10.1093/alcalc/agx100

Cited by 22 publications

(20 citation statements)

References 67 publications

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“…However, with comparable outcomes following LT for other etiologies as well as a low rate of graft failure following recidivism, referrals for ALD patients requiring transplant are anticipated to increase [41–44]. There are a number of potential reasons for an expected increase in the proportion of LTs performed for ALD including a proportional decrease in HCV transplants (with a resultant increase in the proportion of ALD and other non‐HCV etiologies), an improved understanding of the role of LT and patient selection for acute alcoholic hepatitis including the need to obviate the historical six‐month abstinence rule, an evolving understanding of factors influencing recidivism, an increase in HCC in the setting of ALD, and favorable post‐transplant survival relative to other etiologies [45–47].…”

Section: Discussionmentioning

confidence: 99%

Trends in indications and outcomes of liver transplantation in Canada: A multicenter retrospective study

et al. 2021

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Summary The liver transplantation (LT) landscape is continuously evolving. We sought to evaluate trends in indications for LT in Canada and the impact of primary liver disease on post‐LT outcomes using a national transplant registry. Adult patients who underwent a primary LT between 2000 and 2018 were retrospectively identified in the Canadian Organ Replacement Registry. Outcomes included post‐LT patient and graft survival. A total of 5,722 LTs were identified. The number of LT per year increased from 251 in 2000 to 349 in 2018. The proportion of patients transplanted for HCV decreased from 31.5% in 2000 to 3.4% in 2018. In contrast, the percentage of transplants for HCC increased from 2.3% in 2000 to 32.4% in 2018, and those performed for NASH increased from 0.4% in 2005 to 12.6% in 2018. Year of transplant (per 1 year) was protective for both patient (HR:0.96,95%CI:0.94‐0.97; P < 0.001) and graft survival (HR:0.97, 95%CI: 0.96–0.99; P = 0.001). Post‐LT outcomes have improved over time in this nationwide analysis spanning 18 years. Moreover, trends in the indications for LT have changed, with HCC becoming the leading etiology. The decrease in the proportion of HCV patients and increase in those with NASH has implications on the evolving management of LT patients.

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Section: Discussionmentioning

confidence: 99%

Trends in indications and outcomes of liver transplantation in Canada: A multicenter retrospective study

et al. 2021

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“…3 Some may develop greater coping resources, improve adherence behaviors, or stop abusing substances. 22 Patients may also become more overwhelmed or depressed in the setting of new medical challenges. 23 The period that precedes transplantation can also be highly stressful and thus, may not accurately reflect patients’ baseline.…”

Section: Discussionmentioning

confidence: 99%

The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes

et al. 2020

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Background: There is insufficient evidence about the ability of pretransplant psychosocial evaluations to predict posttransplant outcomes. While standardized assessments were developed to increase predictive validity, it is unclear whether the risk scores they yield predict outcomes. We investigated if the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), a scaling approach to those assessments, would have been a superior predictor than the standard psychosocial evaluation. Methods: In this retrospective study, medical records of 182 adult liver transplant recipients who were at least 1 year posttransplant and prescribed tacrolimus for immunosuppression were analyzed. Regression analyses predicted outcomes of interest, including immunosuppressant nonadherence and biopsy-proven rejection, obtained 1-year posttransplant to time of data collection. Nonadherence was determined using the medication level variability index (MLVI). Results: Approximately 49% of patients had MLVI > 2.5, suggestive of nonadherence, and 15% experienced rejection. SIPAT total score did not predict adherence either using the continuous (P = .70), or dichotimized score, above or below > 2.5 (P = .14), or rejection (P = 0.87). Using a SIPAT threshold (total score > 69) did not predict adherence (p = .16) nor was a superior predictor of the continuous adherence score (P = .45), MLVI > 2.5 (P = .42), or rejection (P = 0.49), than the standard evaluation. Conclusion: Our findings suggest that the SIPAT is unable to predict 2 of the most important outcomes in this population, immunosuppressant adherence and rejection. Research efforts should attempt to evaluate the best manner to use psychosocial evaluations.

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“…The magnitude of post-transplantation alcohol relapse is an issue of concern. Reported post-transplant alcohol relapse rates in recipients with ALD range from 15% to 50% [48][49][50][51] . A prospective study 48 of 167 patients found that 42% of the individuals included in the cohort had taken at least one drink by the end of 4.5 years after transplantation, and 26% had engaged in binge drinking.…”

Section: Post-transplantation Relapse Predictors Of Relapse: Risk Stratificationmentioning

confidence: 99%

Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation

Arab

Izzy

Leggio

et al. 2021

Nat Rev Gastroenterol Hepatol

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Post-transplant Outcomes of Persons Receiving a Liver Graft for Alcoholic Liver Disease

Cited by 22 publications

References 67 publications

Trends in indications and outcomes of liver transplantation in Canada: A multicenter retrospective study

Trends in indications and outcomes of liver transplantation in Canada: A multicenter retrospective study

The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes

Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation

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