Most severe alcoholic hepatitis transplant patients achieve 1-year survival

A recent survey of U.S. transplant centers found excellent 1-year survival rates for patients who underwent liver transplantation for severe alcoholic hepatitis, according to data presented at a media press conference for Digestive Disease Week 2018.

“Historically, transplant centers would not consider liver transplantation as an option unless a patient had abstained from drinking alcohol for 6 months,” Saroja Bangaru, MD, chief resident in internal medicine at University of Texas Southwestern Medical Center, said in her presentation. “Only in recent years have studies begun to show excellent outcomes for transplant patients with severe alcoholic hepatitis.”

According to Bangaru, limiting transplant offers to patients who abstained from alcohol was due to a concern that patients would return to drinking after transplantation and a perceived high risk that patients who continued drinking would miss medical appointments, fail to take their immunosuppressant medication, and eventually face graft failure.

“However, not infrequently, patients would receive a diagnosis of severe alcoholic hepatitis during an initial visit, and no one had previously told them to stop drinking,” Bangaru said. “Since their presentation was preceded by active alcohol consumption, they would essentially be rendered ineligible for a transplant at that time.”

Bangaru and colleagues gathered survey data from 45 transplant centers in the U.S. The results showed that 51% are now performing transplantations in patients who had not been sober for 6 months prior, although most of these centers have performed fewer than 5 transplantations in patients with severe alcoholic hepatitis.

Of the centers that have transplanted patients with severe alcoholic hepatitis, 75% reported a 1-year survival of more than 90% and 15% reported a 1-year survival between 80% and 90%.

The researchers also found a near consensus on current listing criteria for severe alcoholic hepatitis including: patient previously unaware of any liver disease (60.9%), complete an official psychosocial evaluation (87%), absence of severe coexisting psychiatric disorder (91.3%), first presentation of severe alcoholic hepatitis (91.3%), and a strong social support system (100%).

“It’s said that these excellent outcomes are fostered by good selection of patients,” Bangaru said. “The hope is that more patients will be evaluated for transplantation.” – by Talitha Bennett

Reference: Bangaru S, et al. Abstract Sa1457. Digestive Disease Week 2018 Media Briefing. Accessed May 21, 2018.

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