Patterns of Alcohol Use After Early Liver Transplantation for Alcoholic Hepatitis.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
BACKGROUND & AIMS: Early liver transplantation (LT) for alcoholic hepatitis (AH) is lifesaving but concerns regarding return to harmful alcohol use remain. We sought to identify distinct patterns of alcohol use post-LT to inform pre-LT candidate selection and post-LT addiction care.
METHODS: Detailed post-LT alcohol use data was gathered retrospectively from consecutive patients with severe AH at 11 ACCELERATE-AH sites from 2006-2018. Latent class analysis identified longitudinal patterns of alcohol use post-LT. Logistic and Cox regression evaluated associations between patterns of alcohol use with pre-LT variables and post-LT survival. A microsimulation model estimated the effect of selection criteria on overall outcomes.
RESULTS: Of 153 LT recipients, 1-, 3-, and 5-year survival were 95%, 88% and 82%. Of 146 LT recipients surviving to home discharge, 4 distinct longitudinal patterns of post-LT alcohol use were identified: Pattern 1 [abstinent](n = 103;71%), pattern 2 [late/non-heavy](n = 9;6.2%), pattern 3 [early/non-heavy](n = 22;15%), pattern 4 [early/heavy](n = 12;8.2%). One-year survival was similar among the 4 patterns (100%), but patients with early post-LT alcohol use had lower 5-year survival (62% and 53%) compared to abstinent and late/non-heavy patterns (95% and 100%). Early alcohol use patterns were associated with younger age, multiple prior rehabilitation attempts, and overt encephalopathy. In simulation models, the pattern of post-LT alcohol use changed the average life-expectancy after early LT for AH.
CONCLUSIONS: A significant majority of LT recipients for AH maintain longer-term abstinence, but there are distinct patterns of alcohol use associated with higher risk of 3- and 5-year mortality. Pre-LT characteristics are associated with post-LT alcohol use patterns and may inform candidate selection and post-LT addiction care.
Swedish Digestive Health Institute
Lee, Brian P; Im, Gene Y; Rice, John P; Lazar, Ann; Weinberg, Ethan; Han, Hyosun; Maddur, Haripriya; Ghobrial, R Mark; Therapondos, George; Hsu, Christine; Fix, Oren K; Eswaran, Sheila; Shetty, Kirti; Chhatwal, Jag; Dalgic, Ozden O; Jakhete, Neha; Mobley, Constance; Victor, David W; Mehta, Neil; Dinges, Lisanne; Rinella, Mary; Schiano, Thomas D; Lucey, Michael R; and Terrault, Norah, "Patterns of Alcohol Use After Early Liver Transplantation for Alcoholic Hepatitis." (2020). Articles, Abstracts, and Reports. 4143.