Six-month Abstinence From Drinking Prior to Liver Transplant Does Not Improve Outcomes in Patients With Alcohol-associated Liver Disease

Alcohol-associated liver disease (ALD) is the leading indication for liver transplant (LT). Most transplant centers require 6 months of cessation from alcohol use prior to consideration for LT. However, this timeframe can increase mortality in patients, particularly those with decompensated ALD who may not have 6 months to wait. This retrospective cohort study compared outcomes in patients with early LT (<6 months alcohol cessation) versus standard LT (≥6 months alcohol cessation) in 1 institution over 8 years.

• Individuals in the study (n=163) were primarily male and white race; ethnic background was not reported.
• Individuals who received early LT had similar 1-year survival compared with those who received standard LT (94% versus 96%, respectively).
• Early LT was not associated with higher odds of return to alcohol use compared with standard LT.
• Younger age in both early LT and standard LT was associated with higher odds of return to hazardous alcohol use* compared with individuals older than 60.
• Patients in both LT groups with early return to alcohol use had reduced survival.
• Treatments for alcohol use disorder were not mentioned in the study.

* Defined as one of the following: heavy episodic drinking (≥5 drinks for men or ≥4 drinks for women per occasion), at-risk drinking (≥14 drinks for men or ≥7 drinks for women per week), or frequent drinking (≥4 days of drinking per week).

Comments: Six months of alcohol abstinence is an arbitrary timeframe to determine patient candidacy for liver transplant. This retrospective study provides evidence that it might not be necessary. The study highlights an opportunity to rethink transplant candidacy requirements for individuals with alcohol use disorder, while raising concerns about other factors such as race, ethnicity, and social status, which may introduce bias in LT candidacy. Addiction expertise on LT services may increase the number of patients who receive transplants and improve patients’ alcohol-related outcomes.

Melissa B. Weimer, DO, MCR

Reference: Herrick-Reynolds KM, Punchhi G, Greenberg RS, et al. Evaluation of early vs standard liver transplant for alcohol-associated liver disease. JAMA Surg. 2021;156(11):1026–1034.