Outcomes of re-referrals of patients with alcohol-associated liver disease, who were previously declined for liver transplantation.

Fecha de publicación: 02/10/2023 Fecha Ahead of Print: 02/10/2023

Autores de IIS La Fe

Tommaso Di Maira

Autor

Participantes ajenos a IIS La Fe

Cox B
Carrique L
Sales I
Don C
Gómez-Aldana A
Koshy D
Abbey S
Lilly L
Tsien C
Bhat M
Jaeckel E
Lynch MJ
Selzner N

Grupos

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

Since 2018, our program has utilized specific psychosocial criteria and a multidisciplinary approach to assess patients for liver transplant due to alcohol-associated liver disease (ALD), rather than the 6-month abstinence rule alone. If declined based on these criteria, specific recommendations are provided to patients and their providers regarding goals for re-referral to increase the potential for future transplant candidacy. Recommendations include engagement in treatment for alcohol use disorder, serial negative biomarker testing, and maintenance of abstinence from alcohol. In our current study, we evaluate the outcomes of patients with ALD, who were initially declined upon assessment and re-referred to our program. This is a retrospective cohort study that includes 98 patients with ALD, who were previously declined for liver transplantation and were subsequently re-referred for liver transplant assessment between May 1, 2018, and December 31, 2021. We assess the outcomes of patients who were re-referred including acceptance for transplantation following a second assessment. Of the 98 patients who were re-referred, 46 (46.9%) fulfilled the recommendations made and proceeded to further medical evaluation. Nine were eventually transplanted; others are listed and are waiting for transplant. The presence of a partner was independently associated with a higher rate of acceptance (OR 0.16, 95% CI: 0.03-0.97, p = 0.05). Most of the patients who did not proceed further (n = 52) were declined again due to ALD contraindications (n = 33, 63.4%), including ongoing drinking and lack of engagement in recommended addiction treatment. Others had medical contraindications (11.2%), clinically improved (6.1%), had adherence issues (5.1%), or lack of adequate support (2%). Patients with ALD previously declined for a liver transplant can be re-referred and successfully accepted for transplantation by fulfilling the recommendations made by the multidisciplinary team. Important factors including ongoing abstinence, engagement in addiction treatment, and social support are key for successful acceptance.

Datos de la publicación

ISSN/ISSNe:: 1527-6465, 1527-6473
Tipo:: Article
Páginas:: 254-261
DOI:: 10.1097/LVT.0000000000000274
Factor de Impacto:: 1,614 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Cox B:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Carrique L:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Di Maira T:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

Liver Transplantation and Hepatology Unit, University Hospital La Fe, Valencia, Spain

CIBERehd, Instituto de Salud Carlos III, Madrid, Spain

Instituto de Investigación. IIS La Fe, Valencia, Spain
Sales I:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Don C:: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Gómez-Aldana A:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Koshy D:: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Abbey S:: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Lilly L:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Tsien C:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Bhat M:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Jaeckel E:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Lynch MJ:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Selzner N:: Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada