Early Liver Transplant for Alcohol-associated Liver Disease Has Excellent Survival but Higher Rates of Harmful Alcohol Use

Abstract

Background and AimsEarly liver transplantation for alcohol-associated liver disease (ALD) has increased worldwide. Short-term outcomes have been favorable, but data on longer-term outcomes are lacking. MethodsSingle-center retrospective study of primary LT recipients between 2010-2020, 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. ResultsOf 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 (IQR 2.6, 7.3). 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 (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 (OR 0.42, p=0.001), but not in a multivariable model (OR 0.71, p=0.33). ConclusionsPatients who undergo ELT for ALD have similar or better survival than other diagnoses in the first 10-years after LT despite a higher incidence of post-LT alcohol use.