Outcomes for Early Liver Transplantation for Alcohol-associated Liver Disease in High-acuity Liver Transplant Recipients with Alcohol Use Disorder

Background. Alcohol use disorder (AUD) incidence is increasing, and alcohol-associated liver disease is the leading indication for liver transplantation (LT) in the United States. Many centers have adopted "early LT"(ELT) for patients with <6 mo of abstinence. This study evaluates whether ELT outcomes in acutely ill recipients are equivalent to standard LT (SLT). Methods. We retrospectively analyzed LTs for alcohol-associated liver disease in patients with AUD at a single center between January 2019 and December 2021. Patients were categorized as ELT (<6 mo) or SLT (≥6 mo). Alcohol relapse was categorized as "abstinent,""slip,"or "harmful,"with use defined by phosphatidylethanol or self-reported consumption. Outcomes were post-LT relapse, graft, and patient survival. Results. Of 183 patients (ELT: 99 [54.1%]; SLT: 84 [45.9%]), ELT recipients were younger, had higher model for end-stage liver disease scores, shorter waitlist times, and were more frequently in intensive care unit pre-LT. Multivariable analysis showed no association in time to post-LT relapse, graft, or patient survival. Intensive care unit status was associated with lower relapse risk (hazard ratio, 0.17; 95% confidence interval, 0.07-0.43; P < 0.001), whereas higher education levels were associated with higher risk (hazard ratio, 2.31; 95% confidence interval, 1.18-4.49; P = 0.014). Conclusions. Pre-LT alcohol abstinence duration does not significantly impact post-LT relapse or survival. ELT should be considered for acutely ill patients with AUD.