Cardiometabolic Risk Factors Impair Recompensation and Survival in Alcohol-associated Liver Disease

Patients with alcohol-associated liver disease (ALD) frequently have cardiometabolic risk factors (CMRFs); however, their association with clinical outcomes remains unclear. We assessed the impact of CMRFs on hepatic recompensation and survival for patients referred for early liver transplant (LT) for ALD.

This multicenter, retrospective cohort study assessed patients with ALD and less than 6 months of sobriety from alcohol who were evaluated for early LT. Data on CMRFs, including body mass index (BMI), history of diabetes (T2DM), hypertension (HTN), and hyperlipidemia (HLD), were collected. Primary outcomes were hepatic recompensation and survival without LT.

Six hundred seventeen patients with a median Model for End-stage Liver Disease (MELD) 3.0 at referral of 27 (interquartile range [IQR], 19-35) were included. A total of 307 patients (50%) were declined for LT or ultimately removed from the waitlist. Having any CMRFs was associated with decreased hepatic recompensation at 6 months (adjusted hazard ratio [aHR], 0.85; 95% confidence interval [CI], 0.74-0.98; P = .03), 12 months (aHR, 0.82; 95% CI, 0.70-0.97; P = .02), and 24 months (aHR, 0.71; 95% CI, 0.57-0.88; P < .01) post LT referral, with T2DM and elevated BMI playing the biggest role. In an adjusted competing risk analysis, higher BMI per kg/m² (subdistribution hazard ratio, 0.97; 95% CI, 0.95-0.98; P < .01) was associated with decreased survival without LT.

CMRFs-particularly T2DM and elevated BMI-were associated with lower recompensation and survival in patients declined for early LT for ALD, even when controlling for disease severity. These findings highlight the importance of considering CMRFs when weighing the potential for recompensation and need for transplantation in patients considered for early LT for ALD.