The Integrated Liver Transplant Engagement and Recovery Network (ILEARN) Project for Post-Liver Transplant Management of Alcohol Use Disorders

Background and Significance:

The most common cause of liver failure requiring liver transplantation in the United States is excessive alcohol consumption. Without liver transplantation, patients with Alcohol Associated Hepatitis (AAH) that fail medical management have a survival rate of ~30% (1). Perhaps, as a consequence of the Covid-19 Pandemic, transplant teams in the U.S. encountered substantial increases in the prevalence of patients with AAH. The U.S. saw relative additions of 105.6% to the transplant waiting list and a 411.8% increase in receipt of liver transplantation (2). Compared to pre-pandemic cases, patients presenting with AAH post-pandemic are younger, sicker and have short or no sobriety time. Pre-Pandemic, many patients referred to alcohol treatment programs were resistant to going because they felt they did not need it, did not “fit in”, or lacked resources. To improve treatment adherence and reduce relapse in this high-risk population, we implemented one of the only outpatient alcohol treatment programs in the U.S. developed exclusively for liver transplant recipients with Alcohol Use Disorders.

Objectives: To describe rates of treatment acceptance, attendance and completion, relapse, health consequences and patient satisfaction in this specialized program, developed as a Quality Improvement initiative.

Method:

A prospective, naturalistic observational study describing the outcomes of a 12-week program of weekly group and individual counseling delivered by a master’s level Certified Addiction Counselor trained in the basics of liver transplantation. Patients were recruited into the treatment program by RW and AG. Treatment consisted of a combination of 12-Step Facilitation, Motivational Interviewing and Cognitive Behavioral Therapy. Results will be compared to the extant literature and national transplant data. If appropriate, regression analysis will be employed to identify factors associated with the primary outcomes.

Preliminary

Results: 3/2021-9/2022

Enrolled: 5 cohorts totaling (N = 46)

Avg age: 49.5 y/o (23-70)

Male: n=26 Female: n=16

Did not complete (n=9).

Reasons for drop out; deceased (n=1), removed (n=2), discharged (n=1), did not engage (n=1) relapsed (n=1), transplanted (n=3).

h/o childhood trauma (n=13)

Relapsed (any drinking) n=6 (n=2 with h/o trauma)

Conclusions/Implications:

Since the start of the Pandemic, the number of AAH patients needing urgent, early liver transplant has increased over 400%. Due to their short sobriety and untreated Alcohol Use Disorders, we developed a novel alcohol treatment program for high-risk patients. We will describe the patient characteristics and outcomes of our program and compare our program to other programs in the literature and national data. We will discuss the challenges and strengths of our program with the audience in order to disseminate information other transplant programs can use to provide their high-risk patients alcohol treatment.

References:

< ![if !supportLists] >1. < ![endif] >Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. JAMA Internal Medicine. 2019;179(3):340-8.

< ![if !supportLists] >2. < ![endif] >Bittermann T, Mahmud N; Abt P. Trends in Liver Transplantation for Acute Alcohol-Associated Hepatitis During the COVID-19 Pandemic in the US. JAMA Network Open. 2021;4(7):e2118713.