Approaching Alcohol Use Disorder After Liver Transplantation for Acute Alcoholic Hepatitis

Peng-Sheng Ting; Ahmet Gurakar; Jason Wheatley; Geetanjali Chander; Andrew M Cameron; Po-Hung Chen

doi:10.1016/j.cld.2021.03.008

Approaching Alcohol Use Disorder After Liver Transplantation for Acute Alcoholic Hepatitis

Clin Liver Dis. 2021 Aug;25(3):645-671. doi: 10.1016/j.cld.2021.03.008. Epub 2021 May 26.

Authors

Peng-Sheng Ting¹, Ahmet Gurakar², Jason Wheatley³, Geetanjali Chander⁴, Andrew M Cameron⁵, Po-Hung Chen⁶

Affiliations

¹ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 431, Baltimore, MD 21287, USA.
² Liver Transplant, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Suite 918, Baltimore, MD 21205, USA. Electronic address: aguraka1@jhmi.edu.
³ Department of Social Work, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie Suite 100, Baltimore, MD 21287, USA.
⁴ Division of General Internal Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 8047A, Baltimore, MD 21287, USA.
⁵ Division of Liver Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 765, Baltimore, MD 21205, USA.
⁶ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 429, Baltimore, MD 21287, USA.

Abstract

Severe alcoholic hepatitis portends a high risk of mortality without liver transplantation. Transplant outcomes in patients with severe alcoholic hepatitis exhibit a strong inverse association with post-transplant alcohol relapse. The ingredients most central to ameliorating alcohol relapse risk may include destigmatized post-transplant alcohol monitoring, a nonpunitive clinician-patient partnership, and multimodal therapies to maintain abstinence and mitigate high-risk drinking. We here review the core principles of post-liver transplant management specific to alcohol use disorder.

Keywords: Alcohol use disorder; Behavioral treatment; Hepatitis; Liver transplantation; Motivational interviewing; Outcomes; Pharmacologic therapy.

Publication types

Review

MeSH terms

Alcohol Abstinence
Alcoholism* / complications
Hepatitis, Alcoholic* / therapy
Humans
Liver Diseases, Alcoholic*
Liver Transplantation*
Patient Selection
Recurrence

Abstract

Publication types

MeSH terms

Grants and funding