Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse - Archive ouverte HAL
Article Dans Une Revue JHEP Reports Innovation in Hepatology Année : 2023

Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse

Résumé

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).
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Dates et versions

hal-04205700 , version 1 (14-09-2023)

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Jules Daniel, Jérôme Dumortier, Arnaud del Bello, Lucie Gamon, Nicolas Molinari, et al.. Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse. JHEP Reports Innovation in Hepatology, 2023, 5 (10), pp.100832. ⟨10.1016/j.jhepr.2023.100832⟩. ⟨hal-04205700⟩
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