The Practice of Retransplantation for Recurrent Alcohol-associated Liver Disease in the United States Is Uncommon With Acceptable Outcomes

Abstract

Liver TransplantationBackground. Alcohol-associated liver disease (ALD) is the leading indication for liver transplantation (LT) in the United States. Alcohol use disorder relapse can lead to graft failure and the need for liver retransplantation (re-LT). Despite the rising incidence of LT for ALD, the practice of re-LT for recurrent ALD is not well understood. We aimed to define the practice of re-LT for recurrent ALD during the last 20 y. Methods. Using the US national transplant registry, adults who underwent re-LT for recurrent ALD were compared with LT recipients who died from recurrent ALD and propensity score-matched re-LT recipients with non-ALD indications. All groups had at least 1-y survival of their primary graft. Kaplan-Meier analysis was used to calculate 1-and 5-y survivals. Results. Between 2000 and 2020, 74 re-LTs were performed for recurrent ALD (1.0% of all re-LTs). There was an increase in recurrent ALD re-LT practice from 2017 to 2020 versus 2014 to 2016 (20 versus 2). At the time of re-LT, patients with recurrent ALD had a significant decrease in body mass index (median 25.1 versus 28.8 kg/m 2 ; P < 0.001) versus the index LT. Patient and graft survivals were similar between patients who underwent re-LT for ALD and non-ALD (56.4% versus 56.9% 5-y graft survival, P = 0.96; 62.8% versus 59.0% 5-y patient survival, P = 0.58). Conclusions. The practice of re-LT for recurrent ALD is uncommon in the United States. Graft and patient survivals seem to be acceptable and support the occasional practice of re-LT for recurrent ALD should the patient be deemed an appropriate candidate.

Liver transplantation for alcohol-associated hepatitis

“…In a recent study using the UNOS database, 74 retransplants were performed for recurrent ALD between 2000 and 2020 (approximately 1% of all liver retransplants nationally). Patients who underwent retransplantation for ALD had similar patient survival (56.4 vs. 56.9%, respectively; P = 0.96) and graft survival (62.8 vs. 59%, respectively; P = 0.58) at 5 years compared with retransplants for other indications [49 ▪▪ ].…”

Racial and Ethnic Disparities in Liver Transplantation for Alcohol-associated Liver Diseases in the United States

“…We read the article entitled “Racial and Ethnic Disparities in Liver Transplantation for Alcohol-associated Liver Diseases in the United States” with great interest. 1 We congratulate the authors for this unique and successful review that identifies the determinants for liver transplant (LT) disparities in patients with alcohol-associated liver disease (ALD).…”

“…There was no difference in waitlist or post-LT outcomes by race or ethnicity in alcohol-associated hepatitis (AH) patients, limited by small subgroups. 1…”

Substance use disorders in organ transplantation: perennial challenges and interprofessional opportunities

“…Using a hypothetical case, the article effectively depicts active and remission phases of a patient's SUD intersecting with SOT including the ‘vehement disagreement’ among selection committee members as they consider retransplantation. These circumstances and controversies are applicable to the question of retransplantation in other recurrent substance use patterns in SOT patients [38 ▪ ,47].…”