Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse.

Autor:	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: nazia.selzner@uhn.ca.
Jazyk:	angličtina
Zdroj:	Gastroenterology [Gastroenterology] 2021 Dec; Vol. 161 (6), pp. 1896-1906.e2. Date of Electronic Publication: 2021 Aug 08.
DOI:	10.1053/j.gastro.2021.08.004
Abstrakt:	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.)
Databáze:	MEDLINE
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