Liver Transplant for Alcohol-Associated Liver Disease

To the Editor Alcohol-associated liver disease depicts a clinical-histologic spectrum of steatosis, alcoholic hepatitis, and alcoholic cirrhosis (AC).¹ A recent guideline posts that decompensated patients with AC should be considered for liver transplant (LT) irrespective of 6-month abstinence.¹ While AC has become the leading indication for LT and prognosis favors patients with AC over other etiologies of cirrhosis, early LT (without the 6-month waiting period) for severe alcoholic hepatitis (SAH) remains a debate.¹ In JAMA Surgery, the study by Herrick-Reynolds et al² revealed that fulfillment of fixed abstinence did not improve post-LT outcomes of patients with alcohol-associated liver disease. Presence of 95.7% AC (vs 49.1% for SAH) supported by explant pathology partially explains the failure of the 6-month sobriety for outcome improvement. Therefore, results concerning the individuals with SAH would be more intriguing.