New protocol prevents heavy alcohol relapse after liver transplantation

In a study published in the Liver Transplantation journal by the American Association for the Study of Liver Diseases, Mayo Clinic researchers found that a new proactive treatment protocol for alcohol use disorder after liver transplant resulted in a 0% heavy alcohol relapse rate among patients who followed the protocol, compared with a historical relapse rate of approximately 25%.

"The results were greater than we expected," says Channa Jayasekera, M.D., Mayo Clinic transplant hepatologist and senior author of the study. "Among the 21 patients in the study, none relapsed to heavy alcohol use within one year. Although this was a small cohort, having no relapses is incredibly encouraging that we have found an effective intervention."

Researchers defined heavy alcohol use as binge drinking - five or more drinks for men or four or more drinks for women on a single occasion - or drinking alcohol more than four days per week. This standard definition reflects a level of alcohol consumption associated with damage to the transplanted liver and other negative health outcomes.

Alcohol-associated liver disease is now the leading indication for liver transplantation in the U.S., and many patients requiring urgent transplantation do not have time to complete traditional alcohol treatment programs before surgery. Historically, transplant care has often focused on monitoring patients after transplant and intervening only after relapse occurs.

Patients who relapse after transplant face a higher risk of serious health complications and may not be eligible for another liver transplant, making relapse prevention a critical part of long-term care.

Researchers at Mayo Clinic in Arizona developed and studied preventing alcohol-related complications after transplantation, or PACT, a first-of-its-kind multidisciplinary protocol designed to proactively prevent alcohol relapse after transplant. The protocol combines anticraving medication, frequent patient follow-up, alcohol metabolite testing, and coordinated care from transplant hepatologists, surgeons, addiction counselors, psychiatrists and pharmacists.

"While a liver transplant can cure alcohol-related liver disease, it does not treat alcohol use disorder," says Dr. Jayasekera. "We increasingly understand alcohol use disorder as a chronic medical condition that deserves proactive treatment, just like other chronic diseases. Our goal is to give patients every possible tool to protect their health and preserve the gift of transplantation."

Researchers say the findings could help reshape how transplant centers nationwide approach addiction treatment after liver transplant and help reduce stigma surrounding alcohol use disorder.

"These patients are often young and have a long future ahead of them after transplant," says Dr. Jayasekera. "If these findings are replicated at other centers, this approach could become a game changer in transplant medicine."

Dr. Jayasekera notes that larger studies and replication at additional transplant centers will be important next steps.