ALCOHOL use disorder medications were associated with significantly improved long term survival among patients with severe alcohol related liver disease undergoing liver transplant evaluation, according to findings from a cohort study involving 1,309 adults.
Alcohol Use Disorder Medications and Survival
Alcohol related liver disease is the leading indication for liver transplantation in the United States, yet the use of medications for alcohol use disorder (MAUDs) remains low. Limited evidence surrounding their benefits in severe liver disease has been considered a major barrier to wider adoption in clinical practice.
Sundaresh and colleagues, from the University of California, USA, evaluated whether treatment with MAUDs was associated with lower mortality among patients with severe alcohol related liver disease referred for liver transplant assessment.
The retrospective cohort study was conducted at a tertiary referral centre and included 1,309 adults referred between January 1st 2016 and December 31st 2022. Participants had a mean age of 57.1 years and 75.6% were male. Mean follow up duration was 38 months.
Significant Long Term Survival Benefit
Patients who received MAUDs for at least 3 months experienced a notable survival advantage compared with those who did not receive treatment for this duration.
One year survival was 6.6% higher among patients receiving MAUDs, while three-year survival was 18.5% higher. The findings suggest that the benefits associated with treatment increase over time in this high-risk population.
Researchers also performed propensity score adjusted multivariable analyses to account for differences in clinical characteristics between groups.
Benefits Persist After Clinical Adjustment
The association between treatment and improved survival remained significant after adjustment for Model for End Stage Liver Disease score, liver transplant status, and other clinical variables.
The adjusted analysis demonstrated a reduced risk of mortality among patients receiving medications for alcohol use disorder: hazard ratio: 0.59; 95% CI: 0.39–0.92.
The authors concluded that improved access to MAUDs may represent an important opportunity to improve outcomes for patients with severe alcohol related liver disease and alcohol use disorder, including those being considered for liver transplantation.
Reference
Sundaresh R et al. Medications for alcohol use disorder among patients with severe alcohol-related liver disease. JAMA Netw Open. 2026;9;(2):e2559016.
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