Abstinence interval before liver transplant shorter now for some alcoholic patients

Last Updated: 2018-05-30

By Megan Brooks

NEW YORK (Reuters Health) - Increasingly, liver transplant centers are doing away with the long-standing practice of delaying liver transplant in patients with severe alcoholic hepatitis (SAH) until they abstain from alcohol for six months, according to a new survey of U.S. transplant centers.

SAH has "an extremely high mortality and steroids are really the mainstay therapy, but some patients do not respond to steroids and a significant percentage of them will die within 3 months. For these patients, liver transplantation is a therapeutic option," Dr. Saroja Bangaru from the University of Texas Southwestern Medical Center in Dallas said during a press briefing on May 21.

"Historically, transplant centers would not consider liver transplant as an option unless a patient had abstained from drinking alcohol for six months due to a concern that the patient would return to drinking after transplant, as well as a perceived high risk that patients who continue drinking would miss medical appointments, fail to take their immunosuppressant medication, and that this would lead to eventual graft failure," said Dr. Bangaru. "Only in recent years have studies begun to show excellent outcomes for patients with severe alcoholic hepatitis."

Dr. Bangaru will present the findings on June 2 during Digestive Disease Week 2018 in Washington, D.C.

Of the 45 U.S. transplant centers Dr. Bangaru and colleagues surveyed, 23 (51%) said they were now performing liver transplants in patients with SAH who had not yet been sober for six months.

Three-quarters (74%) of these centers reported one-year post-transplant survival rates topping 90% and an additional 15% of these centers reported a survival of 80% to 90% at one year, Dr. Bangaru reported.

"It's felt that these excellent outcomes are fostered by good selection of patients. In our survey there was near consensus on liver transplant listing criteria for severe alcoholic hepatitis," said Dr. Bangaru. Almost all of the centers required a strong social support system, the absence of severe co-existing psychiatric disorders, completion of a formal psycho-social evaluation and that this was the first presentation of SAH, she explained.

However, most transplant centers have inadequate post-transplant support for patients. While most provided social workers, only 15 (65%) provided psychiatric therapy and eight (35%) offered group therapy, the researchers found.

SOURCE: https://bit.ly/2IN3nd3

Digestive Disease Week 2018.