Spontaneous Recovery and Mortality in Patients With ALD Referred for Early Liver Transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Internal Medicine

Background:

• Alcohol-associated liver disease (ALD) is a leading cause for liver transplant (LT) in the US.
• Increasing acceptance of LT without mandatory abstinence.
• Spontaneous recovery (SR) is possible for some ALD patients.

Purpose of the Study:

• Evaluate predictors of mortality and SR in ALD patients referred for early LT.
• Identify factors influencing outcomes in this specific patient group.
• Refine LT selection criteria for improved equity.

Main Methods:

• Retrospective cohort study (RESOLVE-ALD) of 607 adults with ALD and <6 months sobriety.
• Data collected between 2018-2021 across six US transplant centers.
• Fine-Gray regression for mortality predictors (LT as competing risk); logistic regression for SR predictors.

Main Results:

• Median MELD 3.0 score was 29; median time from last drink was 2.6 months.
• Higher INR and BUN predicted 12-month mortality.
• 18.5% achieved 12-month SR; lower INR and higher platelet count predicted SR.

Conclusions:

• BUN and platelets are novel predictors of outcomes in ALD patients with short-term abstinence, along with INR.
• These predictors may help refine MELD scores and LT selection criteria.
• Improved criteria can enhance utility and equity in early LT access.