Outcomes of Liver Transplantation Without Alcohol Abstinence in Alcohol-Associated Hepatitis With Original MELD Score ≥30

BACKGROUND Achieving alcohol abstinence before standard liver transplantation (SLT) for alcohol-associated liver disease (ALD) is commonly accepted. However, the 3-month mortality rate for alcohol-associated hepatitis (AH) patients with extremely high Model for End-Stage Liver Disease (MELD) scores (≥30) exceeds 50%, suggesting insufficient time for these patients to achieve sobriety. Current data on outcomes for non-abstinent individuals in this high-risk group undergoing early liver transplantation (ELT) is limited. MATERIAL AND METHODS This single-center observational study (May 2002 to October 2023) involved 1410 liver transplantation (LT) patients. After excluding those with a MELD score <30 (n=1178), no alcohol use (n=166), hepatocellular carcinoma (n=7), viral hepatitis (n=24), and other liver failure (n=1), 34 recipients with ALD were identified. Patients were divided into Group A (abstinence prior to transplant) and Group NA (non-abstinence prior to transplant) based on pre-transplant drinking status, with clinical factors and long-term outcomes compared. RESULTS Among LT recipients who had AH, 94.1% (n=32) were male, with a median daily alcohol consumption of 174 grams and a drinking history of 20 years. Group A had 12 abstinent recipients, 6 of whom maintained sobriety for over 6 months before LT. Long-term survival rates were similar between Group NA and Group A (1, 3, and 5 years after transplant: 75.3%, 69.5%, and 52.1% vs 83.3%, 58.3%, and 48.6%; P=0.908). CONCLUSIONS Pre-transplant alcohol abstinence did not correlate with improved survival in severe AH patients, suggesting that such patients should not be disqualified from LT based solely on alcohol history.