Liver Transplantation for Severe Alcoholic Hepatitis, Updated Lessons from the World's Largest Series

Sharon R. Weeks, Zhaoli Sun, Mary E. McCaul, Heng Zhu, Robert A. Anders, Benjamin Philosophe, Shane E. Ottmann, Jacqueline M. Garonzik Wang, Ahmet O. Gurakar, Andrew M. Cameron

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: Six-month sobriety before transplantation for alcoholic liver disease is typically required but poorly supported by data. We initiated a pilot program after a report of liver transplantation for severe alcoholic hepatitis (SAH) in which the 6-month rule was waived. We previously reported early outcomes; we now provide longer follow-up in the largest cohort of early liver transplantation for SAH in the literature to date. Study Design: Forty-six carefully selected patients with SAH underwent liver transplantation from October 2012 through July 2017; none had been abstinent for 6 months. We also examined 34 patients with alcoholic cirrhosis who received liver transplants under standard protocols with at least 6 months sobriety. We identified patient characteristics and primary outcomes of patient and graft survival, as well as alcohol recidivism. Secondary outcomes included post-transplantation infection, malignancy, and rejection. Results: Compared with patients with alcoholic cirrhosis, SAH patients were younger and with shorter drinking history and higher Model for End-Stage Liver Disease scores at listing and at transplantation. Of these patients, 46% received preoperative steroids; all were nonresponders by Lille score. At a median follow-up time of 532 days (interquartile range 281 to 998 days), there were no significant differences between groups by log-rank testing of Kaplan-Meier estimates for patient and graft survival or alcohol recidivism. Conclusions: In the largest cohort of patients reported, outcomes after liver transplantation for SAH had excellent 1-year outcomes, similar to those seen in patients who received transplants with 6 months of sobriety. Recidivism was similar in the 2 groups. Early liver transplantation for SAH represents life-saving therapy for patients with otherwise high mortality, calling into question the utility of the 6-month rule in predicting outcomes in patients receiving transplants for alcoholic liver disease.

Original languageEnglish (US)
Pages (from-to)549-557
Number of pages9
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Apr 2018

ASJC Scopus subject areas

  • Surgery


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