A multicenter, non-randomized, non-inferiority trial was conducted to evaluate the risk of alcohol relapse 2 years after early liver transplantation for alcohol-related hepatitis versus liver transplantation for alcohol-related cirrhosis after abstinence for at least 6 months. Patients with severe alcohol-related hepatitis that did not respond to medical management and non-transplanted acted as the historical control group. Patients aged 18 years or older were segregated into three groups: the early transplantation group (patients with severe alcohol-related hepatitis not responding to medical treatment and eligible for early liver transplantation), the standard transplantation group (patients with alcohol-related cirrhosis listed for liver transplantation after at least 6 months of abstinence) and not eligible for early transplantation group (patients with severe alcohol-related hepatitis not responding to medical treatment not eligible for early liver transplantation).

The primary end point was the non-inferiority of alcohol relapse rate two years after the transplant in the early transplantation group compared with the standard transplantation group, measured with the alcohol timeline follow back method.

Results showed that 23 (34%) patients relapsed in the early transplantation group and 23 (25%) patients relapsed in the standard transplantation group; hence, the primary end point was not met.Patients in the early transplantation group had a higher alcohol intake at 2 years compared to the standard transplantation group with an absolute difference of 16.7%. Though the time spent in drinking alcohol did not differ between the two groups, those in the early transplantation group consumed alcohol in larger quantities for longer time than the standard transplantation group. The early transplantation group and the standard transplantation group had comparable survival rates at 2 years after the transplant. But compared to the control group and those not eligible for early transplantation, the 2-year overall survival was higher in the patients in the early transplantation group. The authors concluded that though alcohol intake was higher after early liver transplantation, it had survival benefit for patients with severe alcohol-related hepatitis.

Source: Louvet A, et al. Lancet Gastroenterol Hepatol. 2022 Feb 21;S2468-1253(21)00430-1.