Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2016; 8(27): 1149-1154
Published online Sep 28, 2016. doi: 10.4254/wjh.v8.i27.1149
Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease
Kaveh Hajifathalian, Annette Humberson, Mohamad A Hanouneh, David S Barnes, Zubin Arora, Nizar N Zein, Bijan Eghtesad, Dympna Kelly, Ibrahim A Hanouneh
Kaveh Hajifathalian, Mohamad A Hanouneh, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Annette Humberson, Department of Transplant Social Work, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
David S Barnes, Zubin Arora, Nizar N Zein, Ibrahim A Hanouneh, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Bijan Eghtesad, Dympna Kelly, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Hajifathalian K analyzed the data; Zein NN, Eghtesad B and Hanouneh IA designed the research; Hajifathalian K, Humberson A, Arora Z, Barnes DS and Kelly D performed the research; Hajifathalian K, Hanouneh IA, Humberson A and Barnes DS wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Cleveland Clinic Foundation Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors claim no conflict of interest to be declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ibrahim A Hanouneh, MD, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, A30, Cleveland, OH 44195, United States. ibrahim.hanouneh@mngastro.com
Telephone: +1-216-4441762 Fax: +1-216-4446302
Received: April 13, 2016
Peer-review started: April 15, 2016
First decision: May 19, 2016
Revised: June 19, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 28, 2016
Processing time: 162 Days and 13.8 Hours
Abstract
AIM

To evaluate risk of recidivism on a case-by-case basis.

METHODS

From our center’s liver transplant program, we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium (OSOTC) exception criteria. They were considered to have either a low or medium risk of recidivism, and had at least one or three or more months of abstinence, respectively. They were matched based on gender, age, and Model for End-Stage Liver Disease (MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network data.

RESULTS

Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 controls. Nineteen patients (53%) with a median [Inter-quartile range (IQR)] MELD score of 24 (13) received transplant and were followed for a median of 3.4 years. They were matched to 38 controls with a median (IQR) MELD score of 25 (9). At one and five years, cumulative survival rates (± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls, respectively (Log-rank test, P = 0.837). Four (21%) patients resumed drinking by last follow-up visit.

CONCLUSION

Compared to traditional criteria for assessment of risk of recidivism, a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.

Keywords: Alcohol-induced disorders; Alcoholic liver cirrhosis; Mortality; Survival; Liver transplantation

Core tip: For the first time, we report the rates of liver transplant and survival for patients with alcohol-induced cirrhosis who were deemed eligible for liver transplant and listed based on approval under the Ohio Solid Organ Transplantation Consortium medically urgent exception criteria. These criteria allow patients with low to medium risk of recidivism, to receive a liver transplant after only one to three months of abstinence. We showed that transplant rate and short and long term survival after transplant is comparable between these patients and United States general population of patients with alcohol-induced cirrhosis who received liver transplant.