For decades, transplant programs have performed liver transplants on patients with alcohol-related cirrhosis. Most of these patients have not used alcohol for many months, if not years. However, a small subset of patients—many of them younger and female—are presenting with acute alcoholic hepatitis. Historically, liver transplants have not been performed on these patients.
Liver Transplantation in Acute Alcoholic Hepatitis, a conference recently hosted by Baylor University Medical Center, part of Baylor Scott & White Health, brought together experts from around the world to develop guidelines on how to manage patients with this severe form of alcoholic liver disease. In addition to physicians, the more than 130 participants included addiction specialists, social workers, nurses, transplant coordinators, transplant program representatives and insurance company representatives. The guidelines, which are currently being written, will be published soon.
“Many programs are starting to transplant these patients, but everyone has different rules,” says Sumeet Asrani, MD, MSc, a hepatologist on the medical staff of Baylor University Medical Center in Dallas and one of the course directors of the conference. “Our goal at Baylor Scott & White Health was to get all the experts together to develop a consensus among the transplant community and develop the metrics that all programs need to follow. We need to be fair in allocating a scarce resource, which is liver transplant.”
The conference examined all aspects of liver transplantation in the acute alcoholic hepatitis population. Topics included selection criteria, indications and contraindications, listing criteria, ethical considerations and follow-up after liver transplantation.
“Addiction medicine and transplant psychiatry must play a critical role in the evaluation process,” Dr. Asrani says. “A transplant will cure the liver disease but not the alcoholism. Programs that perform liver transplants need to have the right infrastructure and resources in place to treat the alcohol use disorder, as well as the liver disease.”