Beyond Sobriety: How Metabolic Risks Hinder Liver Recompensation in ALD

Key Takeaway

In patients with advanced alcohol-associated liver disease deemed ineligible for liver transplantation, alcohol abstinence alone may not suffice. This multicenter cohort study demonstrates that, even after adjusting for disease severity, type 2 diabetes and excess body weight progressively compromise the liver’s capacity for recompensation and shorten transplant-free survival.

Abstinent, Denied for Transplant, and Deteriorating

The 52-year-old patient has remained completely abstinent from alcohol for three months; yet, his jaundice is pronounced, and his abdomen is tense with ascites. His MELD score hovers in the high 20s. The liver transplant selection committee has convened and issued a denial. Medical management remains the sole course, along with a solitary hope: that alcohol cessation will, as frequently observed, allow hepatic function to rebound. Yet in this patient’s chart lie two additional lines seldom factored into these clinical deliberations: type 2 diabetes and a body mass index of 36. Alcohol-associated liver disease remains the leading cause of liver-related mortality and the most common indication for transplantation across Europe and the…