Preventing Alcohol Relapse After Liver Transplant, with Wei Zhang, MD, PhD

Alcohol use presents a persistent challenge in liver transplantation for patients with alcohol-related liver disease, with relapse remaining a significant risk even after a successful procedure.

Despite the complexity of managing post-transplant alcohol use—compounded by psychiatric comorbidities, social instability, and stigma—innovative care models are emerging to address these gaps, one of which was presented at Digestive Disease Week (DDW) 2025 by Wei Zhang, MD, PhD, a transplant hepatologist at Massachusetts General Hospital and assistant professor at Harvard Medical School.

In December 2022, he and a group of colleagues from Massachussetts General Hospital established the Long-term Individualized Follow-up after Transplant (LIFT) Clinic, a multidisciplinary program involving a hepatologist, a psychiatrist, a social worker, and a case manager to assist in the prevention and management of alcohol relapse in high-risk liver transplant recipients.

Of 41 pts with <2 years’ sobriety at time of liver transplant referred for relapse prevention, 17 (41.5%) attended the clinic, with the initial visit at a mean 8.4 months post-transplant. The clinic connected patients with medications for alcohol use disorder and helped to engage patients in behavioral addiction services. Of note, none of the 17 high-risk patients who attended the clinic for prevention had alcohol relapse during the study follow up period.

“We try to prevent them from relapsing, because once they relapse, they lose some of the incentives after transplant because they already got a transplant,” Zhang explained to HCPLive. “Even if they have relapsed, if we're able to earn their trust, they will be able to get engaged in the care. Obviously we want them to stay stay sober, but sometimes they struggle with this, so we aim to address how they can reduce their drinking, instead of completely stopping.”

Of 38 post-tranaplant patients referred after initial relapse, 21 (55.3%) attended, with the first visit at mean 39 months post-transplant. Medications for alcohol use disorder were started post-relapse in more than 70% of patients, and more than half were connected to behavioral services. While 8 patients continued to drink alcohol, 5 had sustained sobriety >6 months and 8 meaningfully reduced alcohol use.

Loking ahead, Zhang points to the importance of being mindful of relapse in patients considered to be low risk, citing a scenario he encountered with a patient who was sober for 5 years but experienced a severe relapse. Now, the LIFT Clinic has expanded to include all patients who have alcohol as a contributing factor to their liver disease.

“If we find that they have very low risk, we could see them in a longer interval, but if we find any high risk factors in those patients, we start to follow them very closely,” he explained. “I think with this approach, we will provide even better care for those patients, regardless of their risk of relapse.”

Editors’ note: Zhang reports no relevant disclosures.

Reference

1. Rice B, Ivkovic A, Hsu K, et al. EVALUATING THE IMPACT OF A MULTI-DISCIPLINARY CLINIC TO PREVENT ALCOHOL RELAPSE IN HIGH-RISK PATIENTS AFTER LIVER TRANSPLANT FOR ALCOHOL-RELATED LIVER DISEASE. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.