P2 A regional evaluation of outcomes at three months for patients admitted to hospital with decompensated alcohol related cirrhosis

<h3>Introduction</h3> The UK guidelines on liver transplantation for alcohol related cirrhosis require patients to be abstinent from alcohol for at least three months. We measured the outcomes for patients in our region at three months after an admission with decompensated alcohol related cirrhosis. We hypothesised that there may be a cohort of potential transplant candidates who might be referred at that time point. <h3>Methods</h3> A network of clinicians and nurse specialists in East Anglia agreed to collect prospective data on admissions. We included patients admitted with either decompensated alcohol related cirrhosis or alcohol related hepatitis. Data was collected between 1st Feb 2023 and 30th April 2023 and outcomes analysed at three months post admission. We included patients aged 18–70. Non-identifiable data was collected on a template spreadsheet provided to all centres. <h3>Results</h3> Data was provided by 10 centres on 203 patients of whom 59% were male. Patients had a median UKELD of 57 (range 43–67) with 93% having a UKELD&gt;=49, and 47% having Child Pugh C disease. Age was collected as a categorical variable to protect confidentiality and the peak age group was 56–60. On admission, 72% of patients were actively consuming alcohol. Of those, only 48% were reviewed by alcohol services during their admission and a similar proportion (47%) were engaged with alcohol services at three months. Only 35% of patients who were drinking at admission achieved abstinence at 3 months. During the admission 12% of cases were discussed with the local liver unit . Only one patient was transferred to a tertiary centre during the study period. The admission rate to ICU was 10%. In-patient mortality was 11% and overall mortality at 3 months was 25%. We created a transplant decision tree to analyse outcomes at 3 months. The outcome were: 32% not abstinent, 25% dead, 21% medical management, 11% transplanted or being assessed for transplant, 8% lost to follow up, 3% palliative care, 1% had received a Transjugular Intrahepatic Portosystemic Shunt (figure 1). <h3>Conclusions</h3> Admission with decompensated cirrhosis continues to be associated with a high inpatient and 3-month mortality. Despite the critical importance of abstinence only half of patients receive input from alcohol services and only one third achieve abstinence at three months. We identified a population of patients who are abstinent but are being medically managed and might therefore be candidates for liver transplantation.