A STEEEEP learning curve: My take home messages from an Alcohol-associated Liver Disease meeting from a newbie

Posted on: January 3, 2023

– Olivia Stricker, PhD and Commercial Business Development Manager at DiaPharma Group

I recently attended the AASLD Emerging Topics in Alcohol-associated Liver Disease conference in Philadelphia, PA. Although I had been researching clinical practices in alcohol-associated liver disease (ALD) for the past 6 months, I quickly realized how limited my perspective was from only consuming publications and formal guidelines. Prior to attending the conference, I had naively assumed that any given person with ALD could seek out medical attention, said person would be treated, and if necessary, the ALD patient would be placed on the waitlist for a liver transplantation. Then, when a liver became available, the patient would receive the transplant. Quite the contrary, I have since learned that neither the treatment nor transplantation processes for patients with ALD are straightforward, streamlined, transparent, nor promising. There are countless challenges that the medical and non-medical communities face while treating chronic and acute ALD.

Top take home messages:

  • Treatment options have not changed much over the last 20-30 years and even the standard of care (steroids and nutrition) is still a debate in effectiveness.
  • The liver transplantation process is a black box when it comes to selection criteria and can be different from institution to institution and voting group to voting group. Also, VERY LITTLE of the factors that are considered are directly related to liver health status. A “supportive family” and a good attitude are your friend, while previously failed treatment attempts are not your friend.
  • The score most heavily leaned on, MELD, was developed with chronic liver disease scenarios. While it has been validated with alcohol-associated hepatitis (AH) patient groups, it is arguable if this is an apples-to-apples comparison. Since AH patients are acutely sick, MELD tends to put them at the top of the liver transplant waitlist ahead of people that have been waiting for years.
  • Hepatologists treat the liver, not the alcohol-use disorder (AUD). I was super shocked to learn that treatment for AUD is not initiated soooo much earlier in a liver disease progression.
  • “Early” liver transplantation, which is the practice of granting liver transplants without the requirement of 6 months of abstinence, is changing the landscape of liver transplantation practices nationwide and causing controversy because AH patients are perceived by some to be “jumping” to the head of the line. This is creating conflict within the specialty.
  • The scores, tools, and tests available for evaluating liver health, infection status/risk, transplant urgency, etc. are very limited within the field. The fact is, they are not specific to the liver or acute disease, and typically take 4-7 days to produce results. There is a large gap to fill to accurately assess these patients.

For a more nitty gritty detailed perspective from my colleague, Abi Kasberg, PhD, read on HERE.

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