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Im GY, Vogel AS, Florman S, Nahas J, Friedman SL, Aqui S, Ford L, Mirza O, Kim-Schluger L, Schiano TD. Extensive Health Care Utilization and Costs of an Early Liver Transplantation Program for Alcoholic Hepatitis. Liver Transpl 2022; 28:27-38. [PMID: 34133847 DOI: 10.1002/lt.26215] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/24/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022]
Abstract
Early liver transplantation (LT) for severe alcoholic hepatitis (AH) is a rescue therapy for highly selected patients with favorable psychosocial profiles not responding to medical therapy. Given the expected increase of AH candidate referrals requiring complex care and comprehensive evaluations, increased workload and cost might be expected from implementing an early LT program for AH but have not been determined. Some centers may also view AH as a strategy to expeditiously increase LT volume and economic viability. The aim of this study was to determine the health care use and costs of an early LT program for AH. Analyses of prospective databases of AH, interhospital transfers, and the hospital accounting system at a single center were performed from July 2011 to July 2016. For 5 years, 193 patients with severe AH were evaluated at our center: 143 newly referred transfers and 50 direct admissions. Annual increases of 13% led to 2 to 3 AH transfers/month and AH becoming the top reason for transfer. There were 169 (88%) nonresponders who underwent psychosocial evaluations; 15 (9%) underwent early LT. The median cost of early LT was $297,422, which was highly correlated with length of stay (r = 0.83; P < 0.001). Total net revenue of the program from LT admission to 90 days after LT was -$630,305 (-5.0% revenue), which was inversely correlated with MELD score (r = -0.70; P = 0.004) and yielded lower revenue than a contemporaneous LT program for acute-on-chronic liver failure (ACLF; $118,168; 1.4% revenue; P = 0.001). The health care use and costs of an early LT program for AH are extensive and lifesaving with marginally negative net revenue. Significantly increasing care of severe AH patients over 5 years resulted in increased LT volume, but at a lower rate than ACLF, and without improving economic outcomes due to high MELD and prolonged length of stay.
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Affiliation(s)
- Gene Y Im
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander S Vogel
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sander Florman
- Recanati/Miller Transplantation Institute, Division of Abdominal Transplantation, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Nahas
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott L Friedman
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah Aqui
- Recanati/Miller Transplantation Institute, New York, NY
| | - Laura Ford
- Recanati/Miller Transplantation Institute, New York, NY
| | - Omar Mirza
- Department of Psychiatry, The Mount Sinai Medical Center, New York, NY
| | - Leona Kim-Schluger
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas D Schiano
- Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Liver transplantation in patients with alcohol-related liver disease: current status and future directions. Lancet Gastroenterol Hepatol 2020; 5:507-514. [DOI: 10.1016/s2468-1253(19)30451-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
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Wong E, Mullins PD, Wallach JP, Yoshida EM, Erb SR, Ford JA, Scudamore CH, Marquez V. Patients' Perspectives on Early Liver Transplantation in Alcohol-Related Liver Disease. Hepatol Commun 2019; 3:1022-1031. [PMID: 31388623 PMCID: PMC6671774 DOI: 10.1002/hep4.1390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/18/2019] [Indexed: 12/11/2022] Open
Abstract
Liver transplant programs in Canada require a period of 6 months of abstinence from alcohol before considering a patient with liver disease secondary to alcohol for transplantation. Although some studies have demonstrated good outcomes following a transplant in carefully selected patients before the 6‐month abstinence period has been met, there have been arguments against this, including the claim that the public has a general negative perception of those with alcohol dependence. We performed a multicenter cross‐sectional survey to determine the perception of people in British Columbia, Canada, toward liver transplantation in patients with liver disease due to alcohol who have not demonstrated the capacity to remain abstinent from alcohol for 6 months. A total of 304 patient questionnaires were completed, and 83.1% agreed with a period of abstinence of 6 months. In those patients who were unlikely to survive 6 months without a transplant, 34.1% of respondents agreed with, 44.1% did not agree with, and 21.4% were neutral about, early transplantation; 42.8% would have less trust in the process of transplantation if a period of abstinence was not maintained, but relaxing the requirement for an abstinence period would not have an impact on the majority's decision to donate organs. Only 30.5% would support abandoning the abstinence criteria. Conclusion: Among patients followed at general gastroenterology, medicine, or transplant clinics, there is a willingness to relax the criteria in selected patients unlikely to survive without a transplant, although a general consensus remains in support of the existing 6‐month alcohol abstinence rule. A larger scale survey of all provinces in Canada would be required to assess support for such a change in policy.
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Affiliation(s)
- Eric Wong
- Department of Medicine University of British Columbia Vancouver Canada
| | - Paul D Mullins
- Division of Gastroenterology University Hospital of Northern British Columbia Prince George Canada
| | | | - Eric M Yoshida
- Division of Gastroenterology Vancouver General Hospital Vancouver Canada
| | - Sigfried R Erb
- Division of Gastroenterology Vancouver General Hospital Vancouver Canada
| | - Jo-Ann Ford
- British Columbia Hepatitis Clinic, Vancouver General Hospital Vancouver Canada
| | | | - Vladimir Marquez
- Division of Gastroenterology Vancouver General Hospital Vancouver Canada
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Im GY. Outcomes of Liver Transplantation for Severe Alcohol-Related Hepatitis. Clin Liver Dis (Hoboken) 2019; 13:123-127. [PMID: 31236258 PMCID: PMC6544417 DOI: 10.1002/cld.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/15/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gene Y. Im
- Icahn School of Medicine at Mount Sinai, Division of Liver DiseasesRecanati‐Miller Transplantation InstituteNew YorkNY
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Nahas J, Im GY. Early liver transplantation for severe alcoholic hepatitis. Clin Liver Dis (Hoboken) 2018; 11:69-72. [PMID: 30992792 PMCID: PMC6385942 DOI: 10.1002/cld.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jonathan Nahas
- Division of Liver Diseases, Icahn School of Medicine at Mount SinaiRecanati/Miller Transplantation InstituteNew YorkNY
| | - Gene Y. Im
- Division of Liver Diseases, Icahn School of Medicine at Mount SinaiRecanati/Miller Transplantation InstituteNew YorkNY
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Yang SS. Alcoholic Liver Disease in the Asian–Pacific Region with High Prevalence of Chronic Viral Hepatitis. J Med Ultrasound 2016. [DOI: 10.1016/j.jmu.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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