Alcohol-associated liver diseases diagnosis and management

Alcohol looms as the leading cause of liver transplantation in the United States.

Approximately 30% of heavy drinkers (>5 drinks per day for men; >4 drinks per day for women) will develop advanced alcohol-associated liver disease (ALD).

A spectrum of disorders that includes steatohepatitis, cirrhosis, alcoholic hepatitis, and progressive fibrosis, ALD increases the risk for the advance of end-stage liver disease, liver failure, and hepatocellular carcinoma.

The only treatment option offering the potential for cure for these severe conditions is liver transplantation.

However, liver transplantation for individuals with alcohol-induced liver disease has a long history of controversy, extending to a time when alcohol abuse was considered a vice rather than a chronic disease.

As a result, since the 1980s, a tradition in the transplant community precludes many patients with advanced liver disease from live transplantation until they have been abstinent for at least six months, an interim thought to increase the likelihood of successful outcome.

A reconsideration of the six-month rule

However, as Jonathan Dante Nahas, MD, explains, patients with alcohol-associated hepatitis have a six-month mortality of up to 70%, meaning only a minority live to the six-month metric for transplant eligibility.

At the Penn Transplant Institute and elsewhere, this stark finding has spurred a reconsideration of specified periods of sobriety, and led to the adoption of new protocols for patients with ALD seeking liver transplantation.

“About 15 years ago, there was a landmark publication that came out of the New England Journal that looked at transplant without a prespecified period of sobriety, and found that patients who were transplanted in this manner could do well over the long term with great rates of survival and relatively low relapse rates that were not all that different from patients who had been abstinent for 6 months,” Dr. Nahas explains. “So this was a revolution in the field of liver transplant for ALD. And it was adopted at other centers across the world—specifically in the U.S., and right here at Penn.”

Dr. Nahas’ discussion embraces the parameters for candidacy for liver transplantation for individuals with ALD, as well as the physical and psychosocial aspects involved, considerations contributing to successful outcomes, and much else.

Clinical consult and patient referral

To speak with a provider or to refer a patient to Dr. Nahas, please call 877-937-7366. Submit a referral through our secure online referral form.

About Dr. Nahas

Jonathan Dante Nahas, MD, is an Assistant Professor of Clinical Medicine at Penn Gastroenterology and is affiliated with the Penn Liver Diseases Program.

Dr. Nahas sees patients at the Perelman Center for Advanced Medicine and Pennsylvania Hospital in Philadelphia, Pennsylvania.

Episode: Alcohol-associated liver diseases: the waning influence of the six-month rule

Transplant hepatologist Jonathan Nahas, MD shares an overview of alcohol-related liver diseases—addressing their causes, consequences, and effects on the liver. Dr. Nahas offers the importance of thorough assessment and management strategies, including liver transplantation.

Listen to this episode on Apple Podcasts. Spotify, and YouTube Music.