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Three-year Results of a Pilot Program in Early Liver Transplantation for Severe Alcoholic Hepatitis

Lee, Brian P. MD; Chen, Po-Hung MD; Haugen, Christine MD; Hernaez, Ruben MD, PhD; Gurakar, Ahmet MD; Philosophe, Benjamin MD, PhD; Dagher, Nabil MD; Moore, Samantha A. BA; Li, Zhiping MD; Cameron, Andrew M. MD, PhD

doi: 10.1097/SLA.0000000000001831
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Objective: To examine our pilot to transplant selected patients with acute alcoholic hepatitis, initiated in October 2012.

Background: Six months of alcohol abstinence is typically required before liver transplant. A Franco-Belgian protocol showed that early transplant in severe alcoholic hepatitis could improve survival with low incidence of alcohol relapse. Application of this controversial indication is growing despite unclear generalizability.

Methods: Data was collected on all patients with alcohol-related liver disease since initiation of the pilot through June 2015. Patients were stratified into two groups: severe alcoholic hepatitis as first liver decompensation (Group 1), alcoholic cirrhosis with ≥6 months abstinence (Group 2). Alcohol relapse was defined as any evidence of alcohol consumption after transplant, which was assessed for harmful patterns of binge or frequent drinking.

Results: Forty-three patients underwent liver transplant, including 17 patients in Group 1. Six-month survival was 100% versus 89% for Groups 1 and 2, respectively (P = 0.27). Alcohol relapse was similar in Group 1 versus Group 2: 23.5% versus 29.2% (P > 0.99). Harmful drinking was higher in Group 1 versus Group 2, despite lack of statistical significance: 23.5% versus 11.5% (P = 0.42).

Conclusions: In this pilot with carefully selected patients, early liver transplant provided excellent short-term survival, and similar rates of alcohol relapse compared with patients with 6 months of abstinence. Harmful patterns of relapse remain challenging in this population, highlighting the need for validated models to predict alcohol relapse, and need for extreme caution in selecting patients for this exceptional indication. Larger prospective studies and longer follow up are necessary.

*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Reprints: Andrew M. Cameron, MD, PhD, Johns Hopkins University School of Medicine, 765 Ross Bldg, 720 Rutland Ave, Baltimore, MD 21205. E-mail: acamero5@jhmi.edu.

Zhiping Li, MD, Johns Hopkins University School of Medicine, 912 Ross Bldg, 720 Rutland Ave, Baltimore, MD 21205. E-mail: zhipingli@jhmi.edu

B.P.L is a fellow, PH.C. is an assistant professor, C.H. is a resident, R.H., is a fellow, A.G. is an associate professor, B.P. is a professor, N.D. is an assistant professor, S.M. is a visiting medical student, Z.L. is an associate professor and A.M.C. is an associate professor.

The authors and all staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

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