Multicentered study of patient outcomes after declined for early liver transplantation in severe alcohol-associated hepatitis.
Hepatology
; 77(4): 1253-1262, 2023 04 01.
Article
en En
| MEDLINE
| ID: mdl-36651183
ABSTRACT
BACKGROUND:
Early liver transplantation for alcohol-associated hepatitis is controversial in part because patients may recover, and obviate the need for liver transplantation.METHODS:
In this retrospective study among 5 ACCELERATE-AH sites, we randomly sampled patients evaluated and then declined for liver transplantation for alcohol-associated hepatitis. All had Model of End-Stage Liver Disease (MELD) >20 and <6 months of abstinence. Recompensation was defined as MELD <15 without variceal bleeding, ascites, or overt HE requiring treatment. Multilevel mixed effects linear regression was used to calculate probabilities of recompensation; multivariable Cox regression was used for mortality analyses.RESULTS:
Among 145 patients [61% men; median abstinence time and MELD-Na was 33 days (interquartile range 13-70) and 31 (interquartile range 26-36), respectively], 56% were declined for psychosocial reasons. Probability of 30-day, 90-day, 6-month, and 1-year survival were 76% (95% CI, 68%-82%), 59% (95% CI, 50%-66%), 49% (95% CI, 40%-57%), and 46% (95% CI, 37%-55%), respectively. Probability of 1-year recompensation was low at 10.0% (95% CI, 4.5%-15.4%). Among patients declined because of clinical improvement, 1-year probability of recompensation was 28.0% (95% CI, 5.7%-50.3%). Among survivors, median MELD-Na at 30 days, 90 days, and 1-year were 29 (interquartile range 22-38), 19 (interquartile range 14-29), and 11 (interquartile range 7-17). Increased MELD-Na (adjusted HR 1.13, p <0.001) and age (adjusted HR 1.03, p <0.001) were associated with early (≤90 d) death, and only history of failed alcohol rehabilitation (adjusted HR 1.76, p =0.02) was associated with late death.CONCLUSIONS:
Liver recompensation is infrequent among severe alcohol-associated hepatitis patients declined for liver transplantation. Higher MELD-Na and age were associated with short-term mortality, whereas only history of failed alcohol rehabilitation was associated with long-term mortality. The distinction between survival and liver recompensation merits further attention.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Várices Esofágicas y Gástricas
/
Trasplante de Hígado
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Enfermedad Hepática en Estado Terminal
/
Hepatitis Alcohólica
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
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Male
Idioma:
En
Revista:
Hepatology
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos