Kim Sue Hyon, Deutsch-Link Sasha, Serper Marina
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Liver Transpl. 2025 Jun 3. doi: 10.1097/LVT.0000000000000644.
Alcohol use following liver transplantation (LT) is associated with worse outcomes. Strategies for predicting, preventing, and managing alcohol consumption among candidates and recipients of LT with alcohol-associated liver disease (ALD) have historically emphasized complete abstinence. We propose a harm reduction approach as a possible complementary and realistic strategy for managing alcohol use in the context of LT for ALD. In this article, we outline the ethical and clinical foundations for applying harm reduction across the continuum of care for LT in ALD. Although complete alcohol abstinence prevents liver damage, harm reduction promotes shared decision-making that balances liver function with realistic patient circumstances and patient autonomy. Approaches grounded in harm reduction may allow us to improve outcomes across different alcohol consumption patterns and more effectively address health disparities in certain patient groups facing additional challenges in maintaining complete abstinence. Harm reduction strategies may also help prevent psychological distress in candidates and recipients of transplant with ALD and encourage early disclosure of alcohol use that enables timely interventions. Listing procedures and waitlist management for patients with ALD that incorporate principles of harm reduction may also broaden access to life-saving care while maintaining organ utility. Based on clinical evidence, we highlight the need to examine current LT selection processes, coordinate alcohol use disorder treatment for patients with ALD, and develop comprehensive markers of posttransplant success. Finally, we discuss potential challenges and considerations when applying the harm reduction approach to nuanced scenarios of candidates and recipients of LT with ALD.
肝移植（LT）后饮酒与更差的预后相关。在有酒精性肝病（ALD）的LT候选者和受者中，预测、预防和管理酒精消费的策略历来强调完全戒酒。我们提出一种减少伤害的方法，作为在ALD的LT背景下管理酒精使用的一种可能的补充和现实策略。在本文中，我们概述了在ALD的LT连续护理过程中应用减少伤害的伦理和临床基础。虽然完全戒酒可预防肝损伤，但减少伤害促进共同决策，平衡肝功能与现实的患者情况和患者自主权。基于减少伤害的方法可能使我们能够改善不同酒精消费模式下的预后，并更有效地解决某些在维持完全戒酒方面面临额外挑战的患者群体中的健康差距。减少伤害策略还可能有助于预防ALD移植候选者和受者的心理困扰，并鼓励早期披露酒精使用情况以便及时干预。将减少伤害原则纳入其中的ALD患者的 listing 程序和等待名单管理，也可能在维持器官效用的同时扩大获得挽救生命护理的机会。基于临床证据，我们强调需要审视当前的LT选择过程，为ALD患者协调酒精使用障碍治疗，并制定移植后成功的综合指标。最后，我们讨论在将减少伤害方法应用于有ALD的LT候选者和受者的细微差别情况时的潜在挑战和注意事项。
