*PURPOSE: Alcohol-associated liver disease (ALD) is the leading indication for liver transplant (LT) in the United States. Historically, centers have implemented 6 month alcohol abstinence periods prior to LT listing; however, the impact of abstinence time on post-transplant outcomes is unclear. This study evaluated if short-term abstinence is associated with increased rejection post-LT. *METHODS: This single-center, retrospective, cohort included adult LT recipients (LTR) from 11/1/2015 to 7/21/2021 with a primary transplant indication of ALD. Patients were grouped by pre-transplant abstinence time of < 6 or ≥ 6 months. All patients received methylprednisolone induction followed by a steroid withdrawal taper, tacrolimus, and mycophenolate. The primary endpoint was biopsy proven acute rejection (BPAR) at 12 months post-LT. Secondary endpoints were infection, patient and graft survival at 12 months post-LT. *RESULTS: During the study period, 228 LTR met inclusion criteria (< 6 months: n=130; ≥ 6 months: n=98). Patients with < 6 months of abstinence were younger, had higher MELD scores at listing and were more likely to be admitted prior to transplant. Incidence of BPAR within 12 months of LT was 28% in the < 6-month group vs. 18% in the > 6 month group (p= 0.078). BPAR-free survival was greater in the ≥ 6-month group, though was not significantly different (Figure 1). Severity of rejection and number of treated episodes were similar between groups. Tacrolimus exposure was similar throughout the study, except for lower tacrolimus levels within the first two weeks post-LT in the < 6 month group (7 days: 2.9 vs. 3.6 ng/mL; p= 0.041, 14 days: 5.1 vs. 6 ng/mL; p= 0.038). Increased bloodstream infections (21% vs. 7%; p= 0.04) and CMV DNAemia (31% vs. 7%; p=0.0008) were seen in the < 6 month group. Patient and graft survival were similar between groups (Table 2). *CONCLUSIONS: LTR with < 6 months of alcohol abstinence experienced more BPAR, which may be explained by lower tacrolimus exposure early post-LT. Given the high acuity of the short-term abstinence group, the risk of BPAR must be closely balanced with infection risk. [

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]CITATION INFORMATION: Legg K., Sparkes T., Booth I., Maluf D., Bhati C., Jakhete N., Freedman S. Short-Term Alcohol Abstinence Prior to Liver Transplantation and Impact on Rejection AJT, Volume 23, Issue 6, Supplement 1.

Kaitlyn Legg PharmD

University of Maryland Medical Center

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