Reply to: “Comment on <Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse>”

We have jointly written a response to the letter from Natab Shahid. None We thank Nayad Shahid et al. for all of their comments[1]Nayab Shahid, Muhammad Aizaz Ur Rehman; (Response to:''Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse''); https://doi.org/10.1016/j.jhepr.2023.100938.Google Scholar, and we would like to provide answers. We agree that direct biological markers of alcohol consumption are extremely relevant in liver transplantation, but at the time of the first data collection from the people included in this study[2]Daniel J. Dumortier J. Del Bello A. Gamon L. Molinari N. Faure S. et al.(Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse.JHEP Rep. 2023; 5 (PMID: 37681206; PMCID: PMC10480527)100832)https://doi.org/10.1016/j.jhepr.2023.100832Abstract Full Text Full Text PDF Scopus (0) Google Scholar, these markers were unknown and therefore little used. We are currently carrying out prospective studies using these markers. Alcohol associated liver disease has become a recognized indication for LT, and if primary and secondary indications involving this disease (decompensated cirrhosis, hepatocellular carcinoma, alcoholic hepatitis) are combined, more than 40% of patients on the waiting list in France who have consumed excessive amounts of alcoholic beverages. The question of relapse and its consequences is still being debated, but there is no longer any blockage in principle of treating these patients. Concerning the "6-month rule", we would like to share this publication: Addolorato G et al, Liver Transplantation for alcoholic liver disease. Transplantation 2016. A drafting group of which Professor Pageaux was a member, approved by the International Society of Liver Transplantation, was convened to write guidelines on Liver Transplantation for Alcoholic Liver Disease to summarize current knowledge and provide answers to controversial and delicate ethical as well as clinical problems. One of the recommendations concerned the 6-month rule: "The role of the "6-month rule," as a specific time point predicting post-transplantation abstinence is questionable and not evidence based. Decisions on LT candidacy should not be made solely on length of sobriety criterion". Indeed, rather than this so-called rule, it seems better to identify patients who are at risk of severe relapse so that specific care and treatment by an addiction team can be implemented throughout the pre-transplantation and the post-transplantation period. As far as psychological history is concerned, this is not an absolute contraindication, but a risk factor for relapse that is well described in the literature. Addiction treatment takes this criterion into account and accompanies it. This is what we aim to promote in our specific addictology support: exhaustive research into relapse risk factors, and appropriate multi-professional follow-up. The following is/are the supplementary data to this article: Download .pdf (.21 MB) Help with pdf files Response to:''Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse''JHEP ReportsPreviewNayab Shahid: Concept and Idea, Article Search, Literature Review, and Manuscript Writing. Muhammad Aizaz Ur Rehman: Article Search, Literature Review, and Manuscript Writing. Full-Text PDF Open AccessIntegrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapseJHEP ReportsVol. 5Issue 10PreviewLiver 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.