Our Summary

This research paper looks at the potential for living donor liver transplants (LDLT) to be used more frequently for people with severe alcohol-associated hepatitis (AAH), a condition caused by heavy drinking. The authors reviewed existing studies and data to understand the global impact of alcohol-related liver disease and the use of liver transplants as treatment.

They found that early liver transplants from deceased donors have similar outcomes for AAH patients as for other conditions, even when the patient has had less than six months of sobriety. This has led to increasing interest in using LDLT for AAH.

However, the use of LDLT for AAH is currently rare. The authors suggest that countries with experience in liver transplants for AAH or LDLT for other types of acute liver failure are best positioned to increase the use of LDLT for AAH.

The authors also highlight the need for further work in assessing the risk of patients returning to harmful drinking habits after the transplant, and improving the management of alcohol use disorders. They discuss factors relating to both donors and recipients, fairness in allocating transplants, and the financial impact on health systems.

FAQs

  1. What is the potential for living donor liver transplants (LDLT) to be used for people with severe alcohol-associated hepatitis (AAH)?
  2. What are the outcomes of early liver transplants from deceased donors for AAH patients compared to other conditions?
  3. What are the factors that need further work in the use of LDLT for AAH, as discussed by the authors?

Doctor’s Tip

A doctor might advise a patient undergoing a liver transplant to follow a strict medication regimen, attend regular follow-up appointments, maintain a healthy lifestyle, avoid alcohol and certain medications that can harm the liver, and seek support for any underlying alcohol use disorder to ensure the best possible outcome and long-term success of the transplant.

Suitable For

Patients who are typically recommended for liver transplant include those with end-stage liver disease, liver cancer, acute liver failure, or other chronic liver diseases that have progressed to a severe stage. In the case of alcohol-associated hepatitis, patients with severe AAH who have not responded to medical therapy and have a high risk of mortality may be considered for a liver transplant.

It is important for patients to undergo thorough evaluations by a transplant team to determine their eligibility and suitability for a liver transplant. Factors such as the severity of liver disease, overall health status, presence of other medical conditions, and willingness and ability to adhere to post-transplant care and follow-up are taken into consideration when evaluating patients for a liver transplant.

Ultimately, the decision to recommend a liver transplant for a patient is based on a careful assessment of the risks and benefits, as well as the likelihood of a successful outcome. Each patient’s case is unique, and transplant teams work closely with patients to provide individualized care and guidance throughout the transplant process.

Timeline

Before liver transplant:

  1. Patient is diagnosed with severe alcohol-associated hepatitis (AAH) due to heavy drinking.
  2. Patient undergoes evaluation for liver transplant eligibility, including assessments of overall health, alcohol use history, and liver function.
  3. Patient may be required to undergo a period of sobriety before being considered for transplant.
  4. Patient is placed on the waiting list for a deceased donor liver transplant.
  5. Patient may experience worsening symptoms of liver failure while waiting for a suitable donor.

After liver transplant:

  1. Patient undergoes liver transplant surgery, either from a deceased donor or a living donor.
  2. Patient is monitored closely in the hospital for complications and signs of organ rejection.
  3. Patient begins a regimen of immunosuppressive medications to prevent rejection of the new liver.
  4. Patient undergoes regular follow-up appointments with healthcare providers to monitor liver function and overall health.
  5. Patient may need to make lifestyle changes, such as abstaining from alcohol and following a healthy diet, to support the new liver.
  6. Patient may experience improvements in symptoms and overall health following the transplant.
  7. Patient may require ongoing medical care and monitoring for the rest of their life to ensure the success of the transplant.

What to Ask Your Doctor

  1. What are the risks and benefits of a liver transplant for my specific condition (in this case, alcohol-associated hepatitis)?

  2. How long is the waiting list for a liver transplant, and what factors determine my placement on the list?

  3. What is the success rate of liver transplants for alcohol-associated hepatitis compared to other liver conditions?

  4. What is the difference in outcomes between receiving a liver transplant from a deceased donor versus a living donor?

  5. How long is the recovery process after a liver transplant, and what kind of support will I need during this time?

  6. What are the potential complications or side effects of a liver transplant, and how are they managed?

  7. How will my alcohol use disorder be addressed before and after the transplant to prevent relapse?

  8. What is the likelihood of my liver disease recurring after the transplant, and how will it be monitored?

  9. How will my ongoing care and follow-up appointments be managed post-transplant?

  10. What financial considerations should I be aware of regarding a liver transplant, including insurance coverage and potential out-of-pocket costs?

Reference

Authors: Horwich B, Terrault N, Han H. Journal: Expert Rev Gastroenterol Hepatol. 2025 Apr-May;19(5):481-493. doi: 10.1080/17474124.2025.2495824. Epub 2025 May 19. PMID: 40267176