Alcohol-related liver disease is the most common cause of liver failure and alcohol-specific death in the UK. Liver failure due to alcohol is a devastating illness. It causes early death. And can seriously affect survivors and their families. Groups with other disadvantages often face more harm from alcohol.
The rise in alcohol specific deaths has been particularly bad over the last 5 years. This may reflect changes in drinking since the pandemic. In England, alcohol-specific deaths rose by 45% between 2018 and 2023. This rise was especially high in the North East (68%) and East England (55%).
People around the world receive liver transplants for alcohol-related liver failure. This is a very successful treatment. But until now it was more limited in the UK. Transplant was only for people with long-term (chronic) cirrhosis. They also had to stop drinking alcohol for several months.
This meant people with a severe form of the disease couldn’t get a transplant.
Alcohol-related hepatitis happens after recent drinking. Many people have no idea there is anything wrong until they are very seriously ill. Often people come into hospital, get worse, and sometimes die, within a few days or weeks. This means they may have had no opportunity to stop drinking or to get any support to help with this.
The condition can affect people in their 40s, 30s, and even in their 20s. Some will improve on their own or with steroid treatment. But there are few other treatments.
Until now, people with this condition in the UK were not offered transplants. This was mainly because they had no chance to find out if their liver could heal if they stopped drinking. There were also concerns that patients could go back to drinking too much.
However, in the past 10 years, some people in Europe and the United States with alcohol-related hepatitis have had liver transplants. This has shown that some people with the condition have a much greater chance of surviving if they have a transplant. Overall, these transplant recipients did as well as those who had a transplant for long-term alcohol-related liver disease and who had stopped drinking before transplantation. People who had a liver transplant due to alcohol-related hepatitis were slightly more likely to drink again afterwards.
Because of this international experience, the Liver Advisory Group of the NHS Blood and Transplant service set up a Working Group. This group looked at considering transplants for carefully selected patients with alcohol-related hepatitis. They decided it was possible to work out who was most at risk of dying. These people are most likely to benefit from a liver transplant.
Some people with this condition, however, will be too sick to survive a liver transplant. Others will not be offered liver transplantation because their risk of returning to drinking after the transplant is too high.
The working group also looked at support before and after the transplant. People with this condition are usually very unwell. So, it is difficult to do a full psychological assessment. But an assessment similar to one for transplants in France can be done. The group will also look into the best ways to support people to reduce drinking after treatment.
Unfortunately, there are only a limited number of livers available for transplants in the UK. Not everyone who needs a transplant is able to have one. Up to 1 in 10 people on the national waiting list sadly die before they get a liver transplant. So, it is vital that every donor liver goes to someone who will benefit from it.
Even with this new scheme, only a small number of patients with severe alcohol-related hepatitis are likely to meet the transplant criteria. This will be monitored closely in the coming years. Teams will look to make sure that those offered a transplant are the people most likely to benefit from it. They will also make sure there is no negative effect on the UK liver transplant programme as a whole.
This new scheme potentially represents an important advance. It brings the United Kingdom into line with other countries and provides a possible treatment for some extremely ill and vulnerable people.
