studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 811A
1215
Early Liver Transplantation in Severe Alcoholic Hepatitis:
A Multi-Center, Retrospective, Cohort Study
Brian P. Lee 1 , David W. Victor 2 , Darryn R. Potosky 3 , Ibrahim
A. Hanouneh 4 , Mary E. Rinella 5 , Michael D. Voigt 6 , Sheila L.
Eswaran 7 , Howard P. Monsour 2 , R. Mark Ghobrial 2 , Jessica A.
Keppel 7 , Zhiping Li 1 ; 1 Johns Hopkins University School of Medicine,
Baltimore, MD; 2 Houston Methodist Hospital, Houston,
TX; 3 University of Maryland School of Medicine, Baltimore, MD;
4 Cleveland Clinic, Cleveland, OH; 5 Northwestern University Feinberg
School of Medicine, Chicago, IL; 6 University of Iowa Carver
College of Medicine, Iowa City, IA; 7 Rush Medical College, Chicago,
IL
OBJECTIVE: Liver transplant (LT) centers typically require 6
months of alcohol abstinence before a patient is considered
for LT. Severe alcoholic hepatitis (SAH) refractory to medical
treatment has a 6-month survival estimated at 30%. A European
study showed that early LT of SAH in a highly selected
group of patients could improve survival. The purpose of this
study was to examine the outcomes of early LT for SAH in U.S.
transplant centers. METHODS: All 111 U.S. LT centers were surveyed
for patients who underwent LT for acute SAH (Maddrey’s
Discriminant Function >32) as the first presentation of liver
decompensation, and listing for LT prior to 6 months of alcohol
abstinence. 48 centers responded to the survey. 10 centers
reported such experience, of which 7 submitted retrospective
data. All patients presented from October 2006 to November
2014. Alcohol relapse was defined as any alcohol consumption
following LT. Binge drinking was defined as 6 units of
alcohol in a day for men, 4 units for women. Frequent drinking
was defined as any alcohol consumption more than 4 days a
week. RESULTS: 41 patients underwent early LT for acute SAH.
Median follow-up was 2.4 years. Median period of alcohol
abstinence prior to LT listing was 53 days. Median MELD at
listing was 34. Median Maddrey’s discriminant function was
69. Only 12 (29%) received steroids. Of those excluded from
steroid therapy (n=29), 11 (38%) had confirmed infection,
6 (21%) had presumed infection without confirmed source,
5 (17%) had GI bleed, 7 (24%) were excluded due to provider
choice. Six-month and 1-year survival were both 100%.
Overall survival was 89%. 9 (22%) had alcohol relapse; of
these patients (n=9), 6 (67%) reported binge drinking, 7 (78%)
reported frequent drinking, 4 (44%) reported both binge and
frequent drinking, and 4 (44%) had re-achieved sobriety by
time of last follow-up. Compared to the cohort of Mathurin et
al, steroid use was lower (29% vs. 92%, p