Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse
Jules Daniel,
Jérôme Dumortier,
Arnaud Del Bello,
Lucie Gamon,
Nicolas Molinari,
Stéphanie Faure,
Magdalena Meszaros,
José Ursic-Bedoya,
Lucy Meunier,
Clément Monet,
Francis Navarro,
Olivier Boillot,
Georges-Philippe Pageaux,
Hélène Donnadieu-Rigole
Affiliations
Jules Daniel
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
Jérôme Dumortier
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
Arnaud Del Bello
Nephrology and Organ Transplant Department, CHU de Toulouse, Toulouse, France
Lucie Gamon
Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
Nicolas Molinari
Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France; Medical University of Montpellier (UM1), Montpellier, France
Stéphanie Faure
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
Magdalena Meszaros
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
José Ursic-Bedoya
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
Lucy Meunier
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
Clément Monet
Department of Anesthesia and Intensive Care Unit, University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France
Francis Navarro
Medical University of Montpellier (UM1), Montpellier, France; Department of Digestive Surgery, University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
Olivier Boillot
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
Georges-Philippe Pageaux
Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France; Medical University of Montpellier (UM1), Montpellier, France
Hélène Donnadieu-Rigole
Medical University of Montpellier (UM1), Montpellier, France; Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France; Corresponding author. Address: Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, 80 rue Augustin Fliche, 34295 Montpellier CEDEX 5, France. Tel.: +33-0467337020; fax: +33-0467337869.
Background & Aims: Liver transplantation (LT) is a last resort treatment for patients at high risk of mortality from end-stage liver disease. Over the past years, alcohol-associated liver disease has become the most frequent indication for LT in the world. The outcomes of LT for alcohol-associated liver disease are good, but return to alcohol use is detrimental for medium-term survival because of cancer development, cardiovascular events, and recurrent alcohol-associated cirrhosis. Several strategies have been developed to prevent return to alcohol use during the pre- or post-LT period, but there are no specific recommendations. Therefore, the main objective of this study was to investigate if the integration of an addiction team in a LT unit affected the rate of severe alcohol relapse after LT. The secondary objectives were to assess the effects of addiction follow up on cardiovascular events, cancer, and overall survival. Methods: This study was a retrospective comparison between centres with or without addiction monitoring. Results: The study included 611 patients of which 79.4% were male with a mean age of 55.4 years at the time of LT, 190 were managed by an integrated addiction team. The overall alcohol relapse rate was 28.9% and the rate of severe relapse was 13.0%. Patients with addiction follow-up had significantly less frequent severe alcohol relapse than those in the control group (p = 0.0218). Addiction follow up (odds ratio = 0.19; p = 0.001) and age at LT (odds ratio = 1.23; p = 0.02) remained significantly associated with post-LT cardiovascular events. Conclusions: Our study confirms the benefits of integrating an addiction team to reduce return to alcohol use after LT. Clinical Trials registration: This study is registered at ClinicalTrials.gov (NCT 04964687). Impact and implications: The main indication for liver transplantation is alcohol-associated cirrhosis. There are currently no specific recommendations on the addiction monitoring of transplant candidates, although severe return to alcohol use after liver transplantation has a negative impact on long-term survival of patients. In this study, we explored the impact of a systematic addiction intervention on the return to alcohol use rates. In our transplantation centre, we demonstrated the interest of an addiction follow up to limit the severe alcohol relapses rate. This information should be further investigated in prospective studies to validate these data.
