Candidate Selection for Liver Transplantation in Patients with Alcohol-related Liver Disease

PROJECT SUMMARY
Alcohol consumption is a major cause of liver disease worldwide. Severe alcoholic hepatitis (SAH), an acute
manifestation of alcohol-related liver disease (ALD), is associated with inferior short-term survival. Unfortunately,
there are few effective medical therapies for SAH outside of corticosteroids, to which about 40% of patients are
refractory. For these patients, liver transplantation (LT) is the only rescue treatment available. Until recently,
most transplant centers mandated at least six months of continuous abstinence from alcohol before LT.
Unfortunately, this “6-month rule” was(is) often unachievable for patients with SAH, due to recent alcohol use
and high short-term mortality. Several recent studies from Europe and the United States championed the concept
of early liver transplantation (ELT) in this highly vulnerable patient cohort, though post-LT alcohol relapse
remained a concern with adverse consequences like graft injury and cirrhosis.
To date, there is no consensus on the optimal LT candidate selection criteria in ALD, which can lead to uneven
and substandard post-LT outcomes, including alcohol relapse. This project will advance our field in several ways.
First, it will define the impacts of ELT and alcohol abstinence on the natural history of SAH. Second, it will develop
and validate a novel LT candidate selection tool in ALD. The project findings will support a planned multicenter
trial and R01 submission for the external evaluation of the candidate selection tool.
This proposed work represents an interdisciplinary approach toward the optimization and the standardization of
the LT candidate selection process in ALD. To conduct this study, I will integrate myself into the research
community of the NIAAA P50-funded Johns Hopkins DELTA Center for Alcohol Research, which will help me
establish a network of alcohol researchers for current and future collaboration. I will also actively engage in
formal coursework in biostatistics and addiction science as well as interdisciplinary career development
programs. Through the proposed career development plan, I will gain the necessary skills and experience to
establish myself as an independent clinical investigator bridging the fields of hepatology, transplantation, and
addiction medicine.

Grant Number: 5K23AA028297-05
NIH Institute/Center: NIH
Principal Investigator: Po-Hung (Victor) Chen