Beyond Abstinence: How Integrated Multidisciplinary Management Improves Long-term Post Liver Transplant Outcomes

BACKGROUND: Alcohol-associated liver disease is the leading indication for liver transplantation (LT). We assessed long-term alcohol relapse after LT within a program using an integrated multidisciplinary team for relapse monitoring and prevention before and after transplantation, without requiring a predefined abstinence period. METHODS: In 2018, we established a prospective program in which all patients with associated liver disease were evaluated and followed before and after LT by a multidisciplinary team embedded within the transplant program. We reviewed long-term outcomes as part of this program between 2018 and 2023. RESULTS: A total of 165 recipients were transplanted since the inception of the program. Posttransplant alcohol relapse occurred in 21 patients (12.7%), of whom 57.1% had mild alcohol consumption, 4.8% moderate, and 33.3% severe. Median time to relapse was 9.4 mo (5.9-30.2). Ethyl glucuronide positivity confirmed relapse in 20 of 21 patients, and 17 endorsed alcohol use. All patients had access to addiction psychiatry follow-up and relapse prevention therapy embedded within their posttransplant care. Those who relapsed were offered intensification of relapse prevention therapy and 16/21 engaged in regular follow-up. Only 6 patients (3.6%) reported ongoing alcohol consumption at last follow-up, while all others reestablished abstinence. No significant differences in outcomes were observed between groups. No alcohol-related deaths or graft losses occurred. CONCLUSIONS: A multidisciplinary fully integrated team along with individualized approach to candidate evaluation with follow-up pre- and post-LT is critical to successful outcomes and results in a much lower rate of relapse at long-term post-LT.