• Brian P Lee, Po-Hung Chen, Christine Haugen, Ruben Hernaez, Ahmet Gurakar, Benjamin Philosophe, Nabil Dagher, Samantha A Moore, Zhiping Li, and Andrew M Cameron.
• *Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD †Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
• Ann. Surg. 2017 Jan 1; 265 (1): 20-29.

ObjectiveTo examine our pilot to transplant selected patients with acute alcoholic hepatitis, initiated in October 2012.BackgroundSix months of alcohol abstinence is typically required before liver transplant. A Franco-Belgian protocol showed that early transplant in severe alcoholic hepatitis could improve survival with low incidence of alcohol relapse. Application of this controversial indication is growing despite unclear generalizability.MethodsData was collected on all patients with alcohol-related liver disease since initiation of the pilot through June 2015. Patients were stratified into two groups: severe alcoholic hepatitis as first liver decompensation (Group 1), alcoholic cirrhosis with ≥6 months abstinence (Group 2). Alcohol relapse was defined as any evidence of alcohol consumption after transplant, which was assessed for harmful patterns of binge or frequent drinking.ResultsForty-three patients underwent liver transplant, including 17 patients in Group 1. Six-month survival was 100% versus 89% for Groups 1 and 2, respectively (P = 0.27). Alcohol relapse was similar in Group 1 versus Group 2: 23.5% versus 29.2% (P > 0.99). Harmful drinking was higher in Group 1 versus Group 2, despite lack of statistical significance: 23.5% versus 11.5% (P = 0.42).ConclusionsIn this pilot with carefully selected patients, early liver transplant provided excellent short-term survival, and similar rates of alcohol relapse compared with patients with 6 months of abstinence. Harmful patterns of relapse remain challenging in this population, highlighting the need for validated models to predict alcohol relapse, and need for extreme caution in selecting patients for this exceptional indication. Larger prospective studies and longer follow up are necessary.

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