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Tytuł:
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Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse.
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Autorzy:
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Carrique L; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Quance J; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Tan A; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada.
Abbey S; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
Sales I; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Lilly L; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Bhat M; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Galvin Z; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Cattral M; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Ghanekar A; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
McGilvray I; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Reichman T; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Sapisochin G; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Sayed B; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Selzner M; Ajmera Transplant Centre, University Health Network, Toronto, Canada.
Lynch MJ; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada.
Selzner N; Ajmera Transplant Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: .
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Źródło:
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Gastroenterology [Gastroenterology] 2021 Dec; Vol. 161 (6), pp. 1896-1906.e2. Date of Electronic Publication: 2021 Aug 08.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: Philadelphia, PA : W.B. Saunders
Original Publication: Baltimore.
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MeSH Terms:
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Alcohol Abstinence*
Liver Transplantation*/adverse effects
Psychotherapy*
Alcohol Drinking/*prevention & control
Alcoholism/*therapy
Liver Cirrhosis, Alcoholic/*surgery
Alcohol Drinking/adverse effects ; Alcohol Drinking/psychology ; Alcoholism/complications ; Alcoholism/diagnosis ; Alcoholism/psychology ; Biomarkers/blood ; Biomarkers/urine ; Clinical Decision-Making ; Clinical Enzyme Tests ; Female ; Glucuronates/urine ; Humans ; Liver Cirrhosis, Alcoholic/diagnosis ; Liver Cirrhosis, Alcoholic/etiology ; Liver Function Tests ; Male ; Middle Aged ; Patient Selection ; Pilot Projects ; Predictive Value of Tests ; Prospective Studies ; Recurrence ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
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Contributed Indexing:
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Keywords: 6 Months of Abstinence; Alcohol Use Disorder; Alcohol-Related Liver Disease; Biomarker Monitoring; Relapse Prevention Therapy
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Substance Nomenclature:
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0 (Biomarkers)
0 (Glucuronates)
17685-04-0 (ethyl glucuronide)
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Entry Date(s):
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Date Created: 20210809 Date Completed: 20220118 Latest Revision: 20220715
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Update Code:
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20240105
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DOI:
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10.1053/j.gastro.2021.08.004
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PMID:
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34370999
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Background & Aims: In 2018, our team initiated a prospective pilot program to challenge the paradigm of the "6-month rule" of abstinence for patients with alcohol-related liver disease (ALD) requiring transplant. Our pilot involved an in-depth examination of patients' alcohol use, social support, and psychiatric comorbidity, as well as the provision of pre- and post-transplantation addiction treatment.
Methods: Patients with ALD were assessed for inclusion in the pilot by a multidisciplinary team. Relapse prevention therapy was provided directly to all patients deemed to meet the program's inclusion criteria. Random biomarker testing for alcohol was used pre and post transplantation.
Results: We received 703 referrals from May 1, 2018 to October 31, 2020. After fulfilling the program's criteria, 101 patients (14%) were listed for transplantation and 44 (6.2%) received transplants. There were no significant differences in survival rates between those receiving transplants through the pilot program compared with a control group with more than 6 months of abstinence (P = .07). Three patients returned to alcohol use during an average post-transplantation follow-up period of 339 days. In a multivariate analysis, younger age and lower Model for End-Stage Liver Disease scores at listing were associated with an increased likelihood of a return to alcohol use (P < .05); length of abstinence was not a predictor.
Conclusions: Our prospective program provided direct monitoring and relapse prevention treatment for patients with ALD and with less than 6 months of abstinence and resulted in a reduction of post-transplantation return to drinking. This pilot study provides a framework for the future of more equitable transplant care.
(Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Comment in: Gastroenterology. 2022 Jun;162(7):2127-2128. (PMID: 34529993)
Comment in: Gastroenterology. 2021 Dec;161(6):1795-1797. (PMID: 34563475)
Comment in: Gastroenterology. 2022 Jun;162(7):2127. (PMID: 34748773)
Comment in: Hepatobiliary Surg Nutr. 2022 Feb;11(1):153-155. (PMID: 35284518)
Comment in: Hepatobiliary Surg Nutr. 2022 Feb;11(1):150-152. (PMID: 35284528)
