Outcomes and risk of relapse after living donor and deceased donor liver transplantation for alcohol-associated liver disease.

INTRODUCTION AND

OBJECTIVES

The six-month abstinence rule for alcohol-associated liver disease (ALD) patients may exclude candidates from life-saving transplantation without reliably predicting relapse. We compared outcomes of deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) in ALD patients, with modified abstinence criteria.

PATIENTS AND

METHODS

ALD patients evaluated for transplantation from 2008-2020 were analyzed. 6-month abstinence was required for DDLT but not for LDLT patients with favorable psychological assessments. Survival analyses were conducted from evaluation i.e., intention-to-treat (ITT) and transplantation. Patients with living donors were categorized as intended for LDLT (ITT-LDLT) and those without as intended for DDLT (ITT-DDLT). Patients who were ineligible for transplantation served as the control group.

RESULTS

Of the 216 ALD patients evaluated, 79 (36.6%) were accepted for transplantation. Five-year ITT survival was superior in the ITT-LDLT group (83.3%) compared to ITT-DDLT (62.6%, P = 0.04) and controls (30.7%, P < 0.001). Among transplant recipients (DDLT n = 34, LDLT n = 20), five-year graft survival was comparable between DDLT and LDLT (79.8% vs 76.5%, P = 0.84) despite only 40% of LDLT patients achieving six-month abstinence. Alcohol relapse rates were comparable between DDLT and LDLT (32.4% vs. 30.0%, P > 0.99). Alcohol dependence (HR=7.32, P < 0.001) and medical non-compliance (HR=4.19, P = 0.007) predicted relapse.

CONCLUSIONS

Liver transplantation provided significant survival benefit for carefully selected ALD patients. With comprehensive psychological assessment, patients without psychiatric disorders or compliance issues can achieve excellent outcomes after transplantation.