Abstract

Introduction: The traditional “6 months rule” for ALD is becoming debatable with recent evidences showing comparable outcomes without a pre-fixed abstinence period. Method: Abstinence of minimum 3 months being the standard, was made flexible in selected cases where patients' clinical condition with good social support merited early Liver Transplant. Outcomes of all spectrums of ALDs undergoing LT between “June 2011 to September 2017" were analyzed. Recidivism was defined as any alcohol intake after LT and was compared between three groups (A up to 3 months, B 4 to 6 months and C > 6 months). Results: Out of total 159 ALD patients, 148 underwent Living donor LT ad 11 had diseased donor LT. The mean MELD Na was 24 and 65 patients (40.8%) had score > 25. Amongst living donors, 97(65%) were female family members. The median abstinence period was 8 months (range 1 to 84) with 64(43.2%) patients had < 6 months and 23(15.5%) had < 3 months of sobriety. Out of 148 patients, 9 (6.08%) had recidivism, out of which 5(55.5%) died within 6 months. The recidivism rates were 2(8.7%) in Group A, 3(7.3%) in B and 4(4.8%) in C (p value 0.72).The overall survival was significantly lesser in the recidivism group compared to those who didn't resume to alcohol (44.5% vs 89.8%, p = 0.004). Conclusion: Abstinence didn't predict recidivism, provided a promising social support along with strong commitment from patient. Specifically in LDLT settings, abstinence can be made more flexible to benefit patients with high MELD.

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