P1778 - The Alberta Exception Pathway for Liver Transplant for Alcohol-Related Liver Disease Patients Without 6 Months of Abstinence: A Retrospective Look

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Kinjal Patel, MD

University of Alberta
Edmonton, AB, Canada

Kinjal Patel, MD¹, Juan Abraldes, MD, PhD¹, Malcolm Wells, MD¹, Mina Niazi, MD², Vincent Bain, MD¹
¹University of Alberta, Edmonton, AB, Canada; ²University of Saskatchewan, Saskatoon, SK, Canada

Introduction: Increasing evidence supports liver transplant in selected patients with alcohol related liver disease (ALD) without six months of abstinence. Though there is emerging data on those accepted for transplant, there is little data on patients not accepted through this pathway. Studies on candidate selection can help improve the selection criteria.

Methods: Referrals made to on-call hepatologists were documented on paper copies of inclusion criteria checklists. Those meeting criteria were accepted for assessment by a multi-disciplinary team. Patients deemed good candidates were listed for transplant. While on the transplant waitlist, patients underwent random blood alcohol testing as proof of ongoing abstinence.

We retrospectively analyzed data from the inclusion criteria checklists. Chart reviews were conducted to determine date of last follow-up and living status. Statistical analysis were carried out to compare characteristics between patients accepted for assessment and those declined at initial referral. These included average age, average MELD-Na and checklist criteria.

Results: We reviewed 56 referrals to the Exception Pathway from August 2018 to October 2020. Of these, 3 were excluded due to missing data. From the 53 referrals, 37 (70%) were declined at initial triage and 16 (30%) were accepted for full assessment. Although there was no difference in age or sex, the average MELD-Na was higher for accepted patients (37) than those declined (31). Analysis of individual inclusion criteria showed a significant difference between groups for all criteria except for presence of co-morbid drug use (Table 1).

Of the 53 referred, 23 had no evidence of alcoholic hepatitis (AH), 2 were unclear and 14 met criteria. Further criteria were applied to patients with AH. Analysis of these revealed no difference between the groups in regards to non-responsiveness to steroids or previous non-compliance. As compared to those not accepted, accepted patients had no significant difference in survival at last known date of follow-up. Of those accepted for assessment, six were listed for transplant, three were transplanted, two patients died while listed and one improved.

Discussion: Our retrospective study is unique as it characterizes patients not accepted through this pathway. Criteria that showed no difference between groups, raise the question of whether they should be included in the initial assessment. Further data on patients rejected through this pathway is need to help improve selection criteria.

Criteria	Accepted for Assessment (n=16)	Not Accepted for Assessment (n=37)	p-value
Patient has not had previous opportunity to quit drinking	62.5%	5.4%	< 0.001
Patient has insight and acceptance of diagnosis	68.8%	16.2%	< 0.01
Patient has adequate psycho-social support	93.8%	43.2%	0.002
Patient has no recent history of other recreational / illicit drug use (except cannabis)	87.5%	56.8%	0.089

p-value of Pearson Chi-Square, considered statistically significant if < 0.05

Table: Percentage of patients meeting inclusion criteria as compared by whether they were accepted for full assessment or not.

Disclosures:

Kinjal Patel indicated no relevant financial relationships.

Juan Abraldes indicated no relevant financial relationships.

Malcolm Wells indicated no relevant financial relationships.

Mina Niazi indicated no relevant financial relationships.

Vincent Bain indicated no relevant financial relationships.

Kinjal Patel, MD¹, Juan Abraldes, MD, PhD¹, Malcolm Wells, MD¹, Mina Niazi, MD², Vincent Bain, MD¹. P1778 - The Alberta Exception Pathway for Liver Transplant for Alcohol-Related Liver Disease Patients Without 6 Months of Abstinence: A Retrospective Look, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.