P115 Long term outcomes from the UK pilot of early liver transplantation for severe alcohol-related hepatitis

Introduction

Early liver transplantation (eLT) for severe alcohol-related hepatitis (AH) non-responsive to medical therapy has become increasingly common in several countries, in recent years. Excellent survival is reported and alcohol relapse rates are similar to, or slightly higher than, those after LT for standard ARLD cirrhosis in which a period of abstinence is required.¹ In the UK, a pilot program of eLT in severe AH was implemented (2014–2018). Here, we report long-term outcomes.

Methods

The primary endpoint was the number of eligible patients registered, and transplanted using explicit selection criteria (table 1). Briefly, these were severe AH non-responsive to corticosteroids as the first ever presentation of ARLD in a person <40 years old with no other alcohol-related harm nor comorbidity and a favourable psychosocial risk profile. Access to transplantation would be through their unit’s elective adult transplant list with no specific national prioritisation.

Results

The pilot ran between Dec 2014 and January 2018. Nationally, each year there were >3000 hospital admissions with severe AH. In total, 3 patients (2M, 1F) with severe AH were registered with median (range) age 32 (26, 36). At registration, all were non-responders to medical therapy (Lille score ≥0.45) with median (range) bilirubin 338 (238, 542), INR 2.2 (2.1, 2.5), creatinine 112 (79, 194) and UKELD 63 (56, 65). After registration, 1 was delisted due to clinical deterioration and died 40 days post-registration. The other 2 were removed from the waitlist at median 44 (9, 79) due to improvement. Both are still alive at median 83 months (63–102). No patients underwent liver transplantation. The pilot was closed due to low numbers of registrants and a concern about the predictive value of prognostic scores.

Conclusions

Using these strict criteria, very few potential suitable candidates were identified, and none underwent eLT. In addition, 2/3 of those registered for eLT have survived to > 5 years without transplantation, raising concerns about the utility of prognostic scores in accurately predicting transplant-free survival in severe AH in a UK cohort. Furthermore, centre-based offering was unable to deliver expedited organ allocation with all potential registrants being delisted before transplantation could occur. Consequently, early LT for AH has not yet been adopted in the UK. Future development of eLT for severe AH relies on developing robust, validated selection criteria to identify those who will benefit most while also ensuring optimal donor graft utility, and a mechanism to allocate organs in a timely manner.

Reference

Louvet A, et al, Early liver transplantation for severe alcohol-related hepatitis not responding to medical treatment: a prospective controlled study. Lancet Gastro Hep 2022