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Relapse after LT for alcoholic liver disease more common in younger patients
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WASHINGTON — Relapse to alcohol use after liver transplantation for alcoholic liver disease was more common among younger patients, according to a study presented at Digestive Disease Week 2018.
“Alcoholic liver disease is the second most common indication for liver transplant,” Mohanad Turki Ali Al-Qaisi, MD, from the Mayo Clinic in Phoenix, Ariz., said in his presentation. “Timing of alcohol relapse after LT can have a detrimental impact on patient survival.”
Al-Qaisi conducted a retrospective chart review of patients who underwent LT for alcoholic liver disease between 1999 and 2015 with at least 1 year of follow-up to establish the rate of alcohol relapse posttransplant and define predictive factors.
The researchers defined early relapse as any resumption of alcohol use within 1 year posttransplant and late relapse as any resumption of alcohol use after 1 year.
Of the 928 patients included in the study, 203 underwent LT for the first time due to alcoholic liver disease, and 28 patients relapsed within a median follow-up of 6.5 years.
Patients who relapsed were significantly more likely to be younger than those who did not relapse (49.8 vs. 54.1 years; P = .011). Multivariate analysis confirmed the significance of age related to relapse (HR = 1.083; 95% CI, 1.027-1.142).
Patients transplanted under a standardized exception pathway — without 6 months prior sobriety — were also more likely to relapse compared with those who followed normal pathway (40% vs. 12.4%).
Patients who relapsed within 1 year had lower survival compared with those who relapsed after 1 year and those who did not relapse at all, but the difference was not significant.
“We propose patients at risk of relapse should be targeted with intervention shortly after transplant to help improve their outcome,” Al-Qaisi concluded. – by Talitha Bennett
Reference :
Al-Qaisi MTA, et al. Abstract 503. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosure: Al-Qaisi reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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Paul Y. Kwo, MD
Liver transplantation for alcoholic liver disease remains the most common or one of the most common indications for liver transplantation worldwide. Historically, a 6-month sobriety period has been advocated to give the patient time to acquire sobriety skills and select out those who will relapse prior to transplantation, but the data supporting this policy are limited.
The Mathurin pilot study published in 2011 suggested that in carefully selected individuals with severe alcoholic hepatitis who failed to respond to steroids, orthotopic liver transplant could be undertaken with reasonable survival rates. There are ongoing multicenter trials studying patients who are transplanted with alcoholic liver disease and acute alcoholic hepatitis through an exception pathway. This report from the Mayo Clinic extends our knowledge by reporting on 203 patients who underwent transplant for alcoholic liver disease.
Younger age predicted relapse and any alcohol relapse was associated with a lower survival although it was not statistically significant. It will be important to identify the populations at highest risk for relapse posttransplant and intervene proactively in these individuals. With increasing rates of alcohol use disorder, there will be more patients presenting with severe alcoholic hepatitis refractory to medical therapy. Selecting the best candidates for transplant via an exception pathway will be a high priority to best use the scarce resource of a donor liver.
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