1036 Liver Transplant Referral Patterns for Severe Alcoholic Hepatitis With Recent Alcohol Use

Abstract

INTRODUCTION: Liver transplant is the most effective treatment to optimize survivorship in severe alcoholic hepatitis which has a six month mortality rate of 70%. In recent years, multi-center data demonstrated a drastic mortality benefit of early liver transplant and questions the six month alcohol sobriety requirement at some transplant centers. The purpose of this study is to determine whether or not community gastroenterology (GI) providers are aware of the survival benefits of early liver transplant in severe alcoholic hepatitis and to examine what factors impact their decision to refer. METHODS: This study was designed as a cross sectional survey targeting GI providers and fellows within the Washington, DC area. The surveys were distributed both in paper and electronic form via email and local academic meetings. Data was analyzed using Chi-Squared analysis and two sample T-test to detect statistically significant differences between groups. RESULTS: Forty-five surveys were completed by GI physicians (34 attendings, 11 fellows). There was a wide range in the number of years since completion of academic training (range = 0-45 years, average = 14 years). Overall, 40% (17/42) of all participants stated that an active drinking status made them less likely to refer for transplant. Participants who completed training >10 years ago overestimated the rate of alcohol recidivism compared to their counterparts (P = 0.005); however, there was no statistically significant difference in their likelihood to refer active alcohol users for transplant. Although not statistically significant, participants who were more likely to refer active drinkers for transplant completed their last academic training more recently than their counterparts (10 vs 17 years ago, P = 0.14). Factors associated with a higher tendency to refer active users for liver transplant included working for a liver transplant center (P = 0.007) and awareness that peak mortality occurs within two months of last drink (P = 0.001). CONCLUSION: Despite the survival benefits of early liver transplant in severe alcoholic hepatitis, 40% of gastroenterologists surveyed state they are less likely to refer active alcohol users for liver transplant. Education regarding low recidivism rates and drastic benefits in survival outcomes even in patients with less than six months of alcohol sobriety should be disseminated to community gastroenterologists, especially at non-transplant centers.