Jung J, Hasjim BJ, Chen A, Hussain F, Rohan V, Ladner DP, Cheung A. Early liver transplant for alcohol-associated liver disease: Current state and future directions. World J Transplant 2025; 15(4): 104589 [DOI: 10.5500/wjt.v15.i4.104589]
Corresponding Author of This Article
Amanda Cheung, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Northwestern University, 676 N St Clair St, Ste 1900, Chicago, IL 60611, United States. amanda.cheung@nm.org
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Transplantation
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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World Journal of Transplantation
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Jung J, Hasjim BJ, Chen A, Hussain F, Rohan V, Ladner DP, Cheung A. Early liver transplant for alcohol-associated liver disease: Current state and future directions. World J Transplant 2025; 15(4): 104589 [DOI: 10.5500/wjt.v15.i4.104589]
World J Transplant. Dec 18, 2025; 15(4): 104589 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.104589
Early liver transplant for alcohol-associated liver disease: Current state and future directions
Jonathan Jung, Bima J Hasjim, Adrienne Chen, Filza Hussain, Vinayak Rohan, Daniela P Ladner, Amanda Cheung
Jonathan Jung, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
Bima J Hasjim, Department of Surgery, University of California, Irvine Medical Center, Irvine, CA 92697, United States
Adrienne Chen, Vinayak Rohan, Daniela P Ladner, Department of Surgery, Northwestern University, Chicago, IL 60611, United States
Filza Hussain, Department of Psychiatry, Stanford University, Stanford, CA 94301, United States
Amanda Cheung, Department of Gastroenterology and Hepatology, Northwestern University, Chicago, IL 60611, United States
Co-first authors: Jonathan Jung and Bima J Hasjim.
Author contributions: Cheung A, Vinayak R, and Ladner DP were responsible for conceptualization and design; Jung J, Hasjim BJ, Chen A, and Hussain F were responsible for data collection and analysis of results; Jung J was responsible for original draft manuscript preparation; Hasjim BJ, Vinayak R, Hussain F, and Cheung A reviewing and editing manuscript; all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amanda Cheung, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Northwestern University, 676 N St Clair St, Ste 1900, Chicago, IL 60611, United States. amanda.cheung@nm.org
Received: December 25, 2024 Revised: March 17, 2025 Accepted: April 22, 2025 Published online: December 18, 2025 Processing time: 329 Days and 12.8 Hours
Abstract
Alcohol-associated liver disease (ALD) is a rapidly increasing indication for liver transplantation (LT) globally with a significant rise in transplants for ALD with limited sobriety including patients with alcohol-associated hepatitis (AH). This evolution challenges the older paradigm that mandates prolonged periods of alcohol abstinence prior to LT. Due to the limited armamentarium of effective pharmacotherapy to treat severe AH, the mortality rates are significantly higher when LT is not available. In the patients who are transplanted for ALD with limited sobriety including AH, patient and graft survival are equivalent, if not better, compared to patients transplanted for other etiologies. However, due to the risk of alcohol relapse and other psychosocial factors, public opinion regarding early LT may continue to impact how the field moves forward particularly regarding organ stewardship and the need for equitable allocation of organs. Numerous tools for psychosocial evaluations have been developed to assist liver transplant teams to identify appropriate patients in a more uniform manner. In this review, we aim to assess the available evidence to support early LT for alcohol AH and propose directions for the future as the field continues to evolve.
Core Tip: Liver transplantation (LT) for alcohol-associated liver disease continues to be an evolving field. As transplant centers internationally continue to increase rates of transplantation for patients with limited sobriety including alcohol-associated hepatitis, there is an ongoing need to standardize the selection process. This appraisal aims to succinctly review the current state of early LT and anticipate future direction for the field.
