Beyond Abstinence: How Integrated Multidisciplinary Management Improves Long-term Post Liver Transplant Outcomes
Laia Aceituno, Marius Vogelin, Juan Borda, Dilip Koshy, Caitlin Don, Sasha Kanagarayar, Jennifer Brown, Coco Hume, Susan Abbey, Les Lilly, Mamatha Bhat, Cynthia Tsien, Elmar Jaeckel, Christian S. Hendershot, Bernard Le Foll, Marie-Josée Lynch, Nazia SelznerBackground.
Alcohol-associated liver disease is the leading indication for liver transplantation (LT). We assessed long-term alcohol relapse after LT within a program using an integrated multidisciplinary team for relapse monitoring and prevention before and after transplantation, without requiring a predefined abstinence period.
Methods.
In 2018, we established a prospective program in which all patients with associated liver disease were evaluated and followed before and after LT by a multidisciplinary team embedded within the transplant program. We reviewed long-term outcomes as part of this program between 2018 and 2023.
Results.
A total of 165 recipients were transplanted since the inception of the program. Posttransplant alcohol relapse occurred in 21 patients (12.7%), of whom 57.1% had mild alcohol consumption, 4.8% moderate, and 33.3% severe. Median time to relapse was 9.4 mo (5.9–30.2). Ethyl glucuronide positivity confirmed relapse in 20 of 21 patients, and 17 endorsed alcohol use. All patients had access to addiction psychiatry follow-up and relapse prevention therapy embedded within their posttransplant care. Those who relapsed were offered intensification of relapse prevention therapy and 16/21 engaged in regular follow-up. Only 6 patients (3.6%) reported ongoing alcohol consumption at last follow-up, while all others reestablished abstinence. No significant differences in outcomes were observed between groups. No alcohol-related deaths or graft losses occurred.
Conclusions.
A multidisciplinary fully integrated team along with individualized approach to candidate evaluation with follow-up pre- and post-LT is critical to successful outcomes and results in a much lower rate of relapse at long-term post-LT.