Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Liver Transplantation and Hepatology Unit, University Hospital La Fe, Valencia, Spain.
Liver Transpl. 2024 Mar 1;30(3):254-261. doi: 10.1097/LVT.0000000000000274. Epub 2023 Oct 2.
Since 2018, our program has utilized specific psychosocial criteria and a multidisciplinary approach to assess patients for liver transplant due to alcohol-associated liver disease (ALD), rather than the 6-month abstinence rule alone. If declined based on these criteria, specific recommendations are provided to patients and their providers regarding goals for re-referral to increase the potential for future transplant candidacy. Recommendations include engagement in treatment for alcohol use disorder, serial negative biomarker testing, and maintenance of abstinence from alcohol. In our current study, we evaluate the outcomes of patients with ALD, who were initially declined upon assessment and re-referred to our program. This is a retrospective cohort study that includes 98 patients with ALD, who were previously declined for liver transplantation and were subsequently re-referred for liver transplant assessment between May 1, 2018, and December 31, 2021. We assess the outcomes of patients who were re-referred including acceptance for transplantation following a second assessment. Of the 98 patients who were re-referred, 46 (46.9%) fulfilled the recommendations made and proceeded to further medical evaluation. Nine were eventually transplanted; others are listed and are waiting for transplant. The presence of a partner was independently associated with a higher rate of acceptance (OR 0.16, 95% CI: 0.03-0.97, p = 0.05). Most of the patients who did not proceed further (n = 52) were declined again due to ALD contraindications (n = 33, 63.4%), including ongoing drinking and lack of engagement in recommended addiction treatment. Others had medical contraindications (11.2%), clinically improved (6.1%), had adherence issues (5.1%), or lack of adequate support (2%). Patients with ALD previously declined for a liver transplant can be re-referred and successfully accepted for transplantation by fulfilling the recommendations made by the multidisciplinary team. Important factors including ongoing abstinence, engagement in addiction treatment, and social support are key for successful acceptance.
自 2018 年以来，我们的项目利用特定的社会心理标准和多学科方法来评估因酒精性肝病（ALD）而接受肝移植的患者，而不仅仅是基于单独的 6 个月戒酒规则。如果根据这些标准被拒绝，会向患者及其医疗服务提供者提供具体建议，以确定重新转诊的目标，从而增加未来获得移植资格的可能性。建议包括参与酒精使用障碍的治疗、连续进行阴性生物标志物检测以及保持戒酒。在我们目前的研究中，我们评估了最初评估时被拒绝并重新转诊到我们项目的 ALD 患者的结果。这是一项回顾性队列研究，包括 98 名因 ALD 而被先前拒绝接受肝移植的患者，他们随后在 2018 年 5 月 1 日至 2021 年 12 月 31 日期间重新接受肝移植评估。我们评估了重新转诊患者的结果，包括第二次评估后接受移植的情况。在重新转诊的 98 名患者中，有 46 名（46.9%）符合建议并继续接受进一步的医学评估。其中 9 名最终接受了移植；其他人则在等待移植。有伴侣的患者被接受的可能性更高（OR 0.16，95%CI：0.03-0.97，p = 0.05）。大多数没有进一步推进的患者（n = 52）因 ALD 禁忌症（n = 33，63.4%）再次被拒绝，包括持续饮酒和不参与推荐的成瘾治疗。其他人有医学禁忌症（11.2%）、临床改善（6.1%）、有遵医问题（5.1%）或缺乏足够支持（2%）。先前因肝移植而被拒绝的 ALD 患者可以通过满足多学科团队的建议重新转诊并成功接受移植。持续戒酒、参与成瘾治疗和社会支持等重要因素是成功接受的关键。
