Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical, Dallas, Texas, USA.
Hepatol Commun. 2023 May 4;7(5). doi: 10.1097/HC9.0000000000000132. eCollection 2023 May 1.
Liver transplant (LT) is a highly effective therapy for refractory severe alcohol-associated hepatitis (SAH), but optimal selection criteria remain unknown. We aim to evaluate the outcomes of patients who received LT for alcohol-associated liver disease at our center following the introduction of updated selection criteria, including the removal of the minimum sobriety requirement.
Data were collected on all patients who underwent LT for alcohol-associated liver disease from January 1, 2018, to September 30, 2020. Patients were divided into SAH and cirrhosis cohorts based on disease phenotype.
One hundred twenty-three patients underwent LT for alcohol-associated liver disease, including 89 (72.4%) for cirrhosis and 34 (27.6%) for SAH. There was no difference in 1- (97.1 ± 2.9% vs. 97.7 ± 1.6%, p = 0.97) and 3-year (97.1 ± 2.9% vs. 92.4 ± 3.4%, p = 0.97) survival between SAH and cirrhosis cohorts. Return to alcohol use was more frequent in the SAH cohort at 1 year (29.4 ± 7.8% vs. 11.4 ± 3.4%, p = 0.005) and 3 years (45.1 ± 8.7% vs. 21.0 ± 6.2%, p = 0.005) including higher frequencies of both slips and problematic drinking. Unsuccessful alcohol use counseling (HR 3.42, 95% CI 1.12-10.5) and prior alcohol support meetings (HR 3.01, 95% CI 1.03-8.83) predicted a return to harmful alcohol use patterns in early LT recipients. Both duration of sobriety (c-statistic 0.32 (95% CI 0.34-0.43) and SALT score (c-statistic 0.47, 95% CI 0.34-0.60) were independently poor predictors of return to harmful drinking.
Survival following LT was excellent in both SAH and cirrhosis cohorts. Higher rates of return to alcohol use highlight the importance of further individualized refinement of selection criteria and improved support following LT.
肝移植（LT）是治疗难治性严重酒精相关性肝炎（SAH）的有效方法，但最佳选择标准仍不清楚。我们旨在评估我们中心引入更新的选择标准后，因酒精相关性肝病接受 LT 的患者的结局，这些标准包括去除最低戒酒要求。
收集了 2018 年 1 月 1 日至 2020 年 9 月 30 日期间因酒精相关性肝病接受 LT 的所有患者的数据。根据疾病表型，患者分为 SAH 和肝硬化队列。
123 例患者因酒精相关性肝病接受 LT，其中 89 例（72.4%）为肝硬化，34 例（27.6%）为 SAH。SAH 和肝硬化队列在 1 年（97.1 ± 2.9% vs. 97.7 ± 1.6%，p = 0.97）和 3 年（97.1 ± 2.9% vs. 92.4 ± 3.4%，p = 0.97）生存率方面无差异。SAH 队列在 1 年（29.4 ± 7.8% vs. 11.4 ± 3.4%，p = 0.005）和 3 年（45.1 ± 8.7% vs. 21.0 ± 6.2%，p = 0.005）时酒精使用恢复的频率更高，包括更频繁的饮酒失误和有问题的饮酒。早期 LT 受者中，不成功的酒精使用咨询（HR 3.42，95%CI 1.12-10.5）和先前的酒精支持会议（HR 3.01，95%CI 1.03-8.83）预测了有害饮酒模式的恢复。戒酒时间（c 统计量 0.32（95%CI 0.34-0.43）和 SALT 评分（c 统计量 0.47，95%CI 0.34-0.60）都是有害饮酒恢复的独立不良预测因子。
SAH 和肝硬化队列接受 LT 后的生存率均极佳。更高的酒精使用恢复率突显了进一步个体化细化选择标准和 LT 后改善支持的重要性。
