There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH).

The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centres and to compare them with non-responders to medical therapy excluded from eLT.

Patients admitted for sAH (2013 – 2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Post-transplant survival and alcohol relapse were evaluated.

93 patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42-56] years). 45/93 patients received corticosteroids, 52/93 were non-responders and amongst these, 20 patients were wait-listed. Sixteen patients underwent LT. Overall, 6, 12 and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45% and 36%; p<0.001). 2/16 patients resumed alcohol intake, one at 164 days and one at 184 days.

Early LT significantly improves survival in sAH non-responding to medical therapy, when a strict selection process is applied. Further studies are needed to properly assess alcohol relapse rates.