A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement.

Abstract Background and Aims to what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis in the waiting list (WL) for liver transplantation (LT). Methods we conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT-WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestatic- or NASH- decompensated cirrhosis between January 2007 and December 2018. Competing risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. Results one-thousand-and-one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower MELD score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p=0.055). Five years after delisting, cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV decompensated cirrhosis delisted after improvement. Conclusions a significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, that is predicted by low MELD score and higher platelets at WL admission. Women also have higher probability of being delisted after improvement, partially due to a lower early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. Lay summary Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low MELD score and high platelets levels at WL admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are in general favourable.