S1142 The Alberta Exception Pathway for Liver Transplant for Alcohol-Related Liver Disease Patients Without 6 Months of Abstinence: A Retrospective Look

Introduction: Increasing evidence supports liver transplant in selected patients with alcohol related liver disease (ALD) without six months of abstinence. Though there is emerging data on those accepted for transplant, there is little data on patients not accepted through this pathway. Studies on candidate selection can help improve the selection criteria. Methods: Referrals made to on-call hepatologists were documented on paper copies of inclusion criteria checklists. Those meeting criteria were accepted for assessment by a multi-disciplinary team. Patients deemed good candidates were listed for transplant. While on the transplant waitlist, patients underwent random blood alcohol testing as proof of ongoing abstinence. We retrospectively analyzed data from the inclusion criteria checklists. Chart reviews were conducted to determine date of last follow-up and living status. Statistical analysis were carried out to compare characteristics between patients accepted for assessment and those declined at initial referral. These included average age, average MELD-Na and checklist criteria. Results: We reviewed 56 referrals to the Exception Pathway from August 2018 to October 2020. Of these, 3 were excluded due to missing data. From the 53 referrals, 37 (70%) were declined at initial triage and 16 (30%) were accepted for full assessment. Although there was no difference in age or sex, the average MELD-Na was higher for accepted patients (37) than those declined (31). Analysis of individual inclusion criteria showed a significant difference between groups for all criteria except for presence of co-morbid drug use (Table 1). Of the 53 referred, 23 had no evidence of alcoholic hepatitis (AH), 2 were unclear and 14 met criteria. Further criteria were applied to patients with AH. Analysis of these revealed no difference between the groups in regards to non-responsiveness to steroids or previous non-compliance. As compared to those not accepted, accepted patients had no significant difference in survival at last known date of follow-up. Of those accepted for assessment, six were listed for transplant, three were transplanted, two patients died while listed and one improved. Conclusion: Our retrospective study is unique as it characterizes patients not accepted through this pathway. Criteria that showed no difference between groups, raise the question of whether they should be included in the initial assessment. Further data on patients rejected through this pathway is need to help improve selection criteria.Table 1.: Tacrolimus-based immunosuppressive management among liver transplant recipients hospitalized with SARS-CoV-2 infection a Time from positive SARS-CoV-2 PCR nasal swab to tacrolimus trough b AST and ALT values at time of admission Abbreviations: ALT, alanine aminotransferase, aspartate aminotransferase, AST; LT, liver transplant; MMF, mycophenolate mofetil; IS, immunosuppression; Pred, prednisone; Tac, tacrolimus

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