Wei Zhang, MD, PhD: Optimizing Post-Liver Transplant Care for High-Risk Patients

Multidisciplinary alcohol use disorder (AUD) care following liver transplantation may offer a viable approach for preventing and treating alcohol relapse among high-risk liver transplant recipients with alcohol-associated liver disease (ALD), according to findings from a recent study.

The research was presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD), highlighting the successful implementation of a novel co-located multidisciplinary clinic coined Long-term Individualized Follow-up to Transplant (LIFT) for addressing concerns about post-transplant alcohol relapse and improving outcomes in this patient population.

“Even after very careful selection, for those patients to receive liver transplants, there's still a lot of patients who could experience relapse,” Wei Zhang, MD, PhD, a transplant hepatologist at Massachusetts General Hospital and an assistant professor at Harvard Medical School, said in an interview with HCPLive.

Zhang acknowledged that although there has been a notable amount of progress made in making transplants available to patients with ALD, more of their post-transplant care needs to be focused on addressing their AUD and not just their hepatic health. Recognizing the availability of specialized care for these patients but its lack of integration into standard post-transplant care, he said this is what inspired the creation of the LIFT clinic.

LIFT comprised a hepatologist, a psychiatrist, a social worker, and a case manager. Patients who received liver transplants for ALD and were considered high risk for relapse, as well as those who had already relapsed, were referred to the clinic.

Between December 2022 and April 2024, 73 post-liver transplant patients were referred to the LIFT clinic, with a total of 37 patients seen during this period. Among the cohort, 17 (46%) patients were female and 33 (89%) were Caucasian with an average age of 51.62 ± 10.04 years.

In total, 18 (49%) patients had not consumed alcohol by the time of referral (prevention group), whereas 19 (51%) had experienced a relapse at the time of referral (treatment group). Prior to transplantation, 33 (89.2%) patients had a diagnosis of AUD, with 15 (40.54%) achieving < 6 months of abstinence before transplant and 11 (29.73%) maintaining abstinence for 6-12 months prior to transplantation.

During an average follow-up of 9.00 ± 5.11 months, no patients in the prevention group relapsed during the study period. A single patient died from recurrent alcohol-associated cirrhosis in the treatment group. Among the remaining 18 patients in the treatment group, 7 (38.89%) achieved abstinence, 6 (33.33%) exhibited decreased phosphatidylethanol (PETh) levels, and 4 (22.22%) had higher PETh levels compared to their pre-LIFT visit levels; one did not have PETh tests during follow-ups.

“The clinical is quite small and we still have to see how effective this preventative measure is long-term,” Zhang said. “We also have to explore how other centers can learn from us and how we can help other centers create this kind of clinic to prevent alcohol relapse.”

Reference

^{Zhang W, Ivkovic A, Schoener K, et al. Feasibility and Early Outcomes of a Novel Multidisciplinary Post-Liver Transplant Alcohol Use Disorder Clinic: The Long-term Individualized Follow-up after Transplant (LIFT) Experience. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}