Early liver transplantation for alcohol-associated liver disease (ALD) is associated with good long-term survival
Musto JA et al, Clin Gastroenterol Hepatol. 2024;22(8):1646–56.e2
In this study, the long-term survival and alcohol consumption of patients who underwent liver transplantation for ALD without alcohol abstinence and those who were transplanted after 6 months of alcohol abstinence as well as people who were transplanted for another indication (not alcohol-related) were examined. Although patients who had not abstained from alcohol prior to transplantation were more likely to relapse into harmful alcohol consumption patterns, long-term survival was better than for patients who were transplanted due to non-alcohol-related liver disease and comparable to that of people who had abstained from alcohol for 6 months before transplantation.
Background and aims: Early liver transplantation (LT) for alcohol-associated liver disease (ALD) has increased worldwide. Short-term outcomes have been favorable, but data on longer-term outcomes are lacking.
Methods: Single-center retrospective study of primary LT recipients between 2010 and 2020, with follow-up through July 1, 2022. Survival analysis was performed using log rank, Cox models, and Kaplan-Meier method. Cox models were created to identify variables associated with mortality; logistic regression to identify variables associated with post-LT alcohol use.
Results: Of 708 patients who underwent LT, 110 (15.5%) had ALD and abstinence < 6 months prior to LT (ELT), 234 (33.1%) had ALD and alcohol abstinence > 6 months (SLT), and 364 (51.4%) had non-ALD diagnoses. Median follow-up was 4.6 years (interquartile range, 2.6–7.3 years). ELT recipients were younger (p = 0.001) with median abstinence pre-LT of 61.5 days. On adjusted Cox model, post-LT survival was similar in ELT and SLT (hazard ratio [HR] = 1.31; p = 0.30) and superior to non-ALD (HR = 1.68; p = 0.04). Alcohol use (40.9% vs. 21.8%; p < 0.001) and harmful alcohol use (31.2% vs. 16.0%; p = 0.002) were more common in ELT recipients. Harmful alcohol use was associated with post-LT mortality on univariate (HR = 1.69; p = 0.03), but not multivariable regression (HR = 1.54; p = 0.10). Recurrence of decompensated ALD trended toward more common in ELT (9.1% vs. 4.4%; p = 0.09). Greater than 6 months pre-LT abstinence was associated with a decreased risk of harmful alcohol use (odds ratio [OR] = 0.42; p = 0.001), but not in a multivariable model (OR = 0.71; p = 0.33).
Conclusions: Patients who undergo early liver transplantation (LT) for alcohol-associated liver disease have similar or better survival than other diagnoses in the first 10 years after LT despite a higher incidence of post-LT alcohol use.