Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse

Carrique, Lauren; Quance, Jill; Tan, Adrienne; Sales, Isabel M.; Lilly, Les; Bhat, Mamatha; Galvin, Zita; Cattral, Mark S.; Ghanekar, Anand; McGilvray, Ian; Reichman, Trevor; Sayed, Blayne A.; Selzner, Markus; Lynch, Marie‐Josée; Selzner, Nazia

doi:10.1053/j.gastro.2021.08.004

Cited by 47 publications

(46 citation statements)

References 28 publications

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“…The under-utilization of effective interventions for AUD in ALD patients could potentially be improved by the implementation of multidisciplinary teams treating both the addiction, the liver-related complications, comorbidities, and the other psychosocial components. 156…”

Section: Discussionmentioning

confidence: 99%

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Treating Alcohol Use Disorder in Patients with Alcohol-Associated Liver Disease: Controversies in Pharmacological Therapy

2022

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Alcohol use disorder (AUD) is one of the main causes of global death and disability. The liver represents the main target of alcohol damage and alcohol associated liver disease (ALD) represents the first cause of liver cirrhosis in Western Countries. Alcohol abstinence is the main goal of treatment in AUD patients with ALD, because treatments for ALD are less effective when drinking continues. Moreover, the persistence of alcohol consumption is associated with higher mortality, increased need for liver transplantation and graft loss. The most effective treatment for AUD is the combination of psychosocial interventions, pharmacological therapy and medical management. However, the effectiveness of these treatments in patients with ALD are doubtful even because AUD patients with ALD are usually excluded from pharmacological trials due to concerns on liver safety. This narrative review will discuss the treatment options for AUD-ALD patients focusing on controversies in pharmacological therapy.

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Section: Discussionmentioning

confidence: 99%

“…156 GBD 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.…”

mentioning

confidence: 99%

Treating Alcohol Use Disorder in Patients with Alcohol-Associated Liver Disease: Controversies in Pharmacological Therapy

2022

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“…Patients receiving early LT had similar 1-year survival (94.1% vs. 95.9%, respectively, p=0.60) but also similar relapse-free survival (80.4% vs. 83.5%, respectively, p=0.41) and allograft survival (92.7% vs. 90.5%, respectively, p=0.42) (30) than patients receiving standard LT. Furthermore, the duration of abstinence <6 months before LT alone does not accurately predict the risk of relapse after LT compared to other factors such as the presence of psychiatric comorbidities or a High-Risk Alcoholism Relapse score >3 (31)(32)(33)(34). A recent pilot study even observed a lower alcohol relapse rate in patients receiving LT after less than 6 months of abstinence as long as addictological follow-up was reinforced (33).…”

Section: Evaluation Of Addiction Before Lt For Arldmentioning

confidence: 99%

“…Furthermore, the duration of abstinence <6 months before LT alone does not accurately predict the risk of relapse after LT compared to other factors such as the presence of psychiatric comorbidities or a High-Risk Alcoholism Relapse score >3 (31)(32)(33)(34). A recent pilot study even observed a lower alcohol relapse rate in patients receiving LT after less than 6 months of abstinence as long as addictological follow-up was reinforced (33). Despite these encouraging data, certain individuals in the public and even certain philosophers and physicians view ARLD as a self-inflicted disease and feel that these patients J o u r n a l P r e -p r o o f should be given lower priority for LT (25,(35)(36)(37).…”

Section: Evaluation Of Addiction Before Lt For Arldmentioning

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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“…Individuals with concomitant cirrhosis and AUD are at increased risk of experiencing adverse health consequences attributable to their liver disease, in addition to psychological stress, financial hardship, and homelessness [ 5 ]. Despite these negative consequences, and the evidence to support the benefit of AUD related treatment [ 6 , 7 ], less than 20% of individuals with AUD receive psychological/behavioural therapy with or without pharmacotherapy for relapse prevention [ 1 ]. While current statistics are lacking for Canada, a recent study in the United States found that among 21,270 adults with AUD, only 5.8% reported receiving treatment [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis

Johnson

Ghosh

Daniels

et al. 2022

Addict Sci Clin Pract

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Background Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. Methods We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. Conclusion This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.

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Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse

Cited by 47 publications

References 28 publications

Treating Alcohol Use Disorder in Patients with Alcohol-Associated Liver Disease: Controversies in Pharmacological Therapy

Treating Alcohol Use Disorder in Patients with Alcohol-Associated Liver Disease: Controversies in Pharmacological Therapy

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

Clinicians’ perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis

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