Clinical question: How does the duration of abstinence from alcohol affect patient survival, allograft survival, and relapse-free survival in patients undergoing liver transplantation?
Background: Historically, abstinence from alcohol for at least six months has been a criterion used to determine which patients qualify for liver transplantation (LT). While this abstinence requirement has been shown to improve mortality in patients with alcohol-related liver disease (ALD), it has not been well studied in patients with severe alcoholic hepatitis (SAH) who are unlikely to survive more than six months without LT.
Study design: Retrospective cohort study
Synopsis: This study included data from 163 patients who underwent LT at Johns Hopkins Hospital, Baltimore, and were divided into two groups: early LT (<6 months of abstinence) versus standard LT (>6 months of abstinence). Results showed that adherence to the six-month abstinence rule did not lead to superior outcomes in terms of one-year patient survival (94.1% versus 95.9%), allograft survival (92.7% versus 90.5%) or relapse-free survival (80.4% versus 83.5%).
This study questions LT candidacy requirements given that the duration of abstinence does not affect one-year patient mortality, allograft survival, or relapse-free survival in a statistically significant manner.
Limitations of this study include: being a single-center study, and that patients in the study were primarily white males. Also, the treatments for alcohol use disorder were not reported.
Bottom line: Patients with >6 months of abstinence from alcohol do not have superior post-transplant one-year survival when compared to patients with <6 months of abstinence.
Citation: Herrick-Reynolds KM, et al. Evaluation of early vs standard liver transplant for alcohol-associated liver disease. JAMA Surg. 2021;156(11):1026-1034.
Dr. Sheikh is associate program director for the department of internal medicine and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.