When Should Patients With Less Than 6 Months Sobriety Be Transplanted?

Area of Science:

• Hepatology
• Transplantation Medicine
• Public Health

Background:

• Alcoholic liver disease (ALD) and alcohol-related deaths have significantly increased in the past two decades.
• Patients with end-stage ALD are frequently referred for liver transplantation with a prognosis of less than six months.
• Traditional transplant criteria often contraindicate listing for patients with less than six months of sobriety due to the stigmatization of ALD.

Purpose of the Study:

• To outline the development of a liver transplant program for patients with end-stage alcoholic liver disease (ALD) and less than six months of sobriety.
• To address the need for revised protocols and institutional changes to accommodate this patient population.
• To challenge the historical 6-month sobriety requirement for liver transplant listing in ALD patients.

Main Methods:

• Development of new clinical protocols for evaluating and managing patients with end-stage ALD.
• Resource allocation and system reworking within a large, urban, academic liver transplant program.
• Transformation of team and institutional culture to support expanded transplant criteria.

Main Results:

• The abstract outlines the steps taken by a major academic liver transplant program.
• Focus on developing a program for patients with end-stage ALD and less than six months sobriety.
• Implies a shift from historical contraindications to a more inclusive approach.

Conclusions:

• The historical 6-month sobriety requirement for liver transplantation in alcoholic liver disease (ALD) patients may not be the sole determining factor for access.
• Implementing new protocols, resources, and cultural shifts is crucial for adapting clinical practice.
• This initiative represents a significant step towards improving transplant access for critically ill ALD patients.