Behavioural Alcohol Use Disorder Therapy During Liver Transplant Evaluation: Liver Transplantation | July 2026

Introduction:

Liver transplantation is increasingly being offered to carefully selected patients with alcohol-associated liver disease (ALD) who have less than six months of sobriety. This multicenter study evaluated whether behavioural alcohol use disorder therapy (bAUDT) during liver transplant evaluation improves transplant eligibility and influences alcohol relapse before or after transplantation.

Why was this study needed?

• More transplant centres are evaluating patients with early sobriety (<6 months).
• Behavioural alcohol use disorder therapy is increasingly incorporated into transplant evaluation, but its impact remains uncertain.
• The relationship between bAUDT, transplant listing, and alcohol relapse has not been well defined.
• Barriers to accessing behavioral therapy may affect transplant equity.
• Evidence is needed to optimize pre-transplant addiction care.

Results:

• Participation in behavioral alcohol use disorder therapy significantly increased the likelihood of liver transplant waitlisting, suggesting an important role in improving transplant eligibility.
• Behavioral therapy did not independently reduce the risk of alcohol relapse before or after liver transplantation, indicating that participation alone should not be considered a predictor of long-term abstinence.
• Older age, underinsurance, and inpatient transplant evaluation reduced participation in behavioral therapy, highlighting important socioeconomic and healthcare access barriers.

Clinical Impact:

This multicenter study supports integrating behavioral alcohol use disorder therapy into the liver transplant evaluation process, primarily because it facilitates transplant listing and multidisciplinary assessment, rather than because it directly predicts post-transplant sobriety. Improving access to addiction services, particularly for socially vulnerable patients, should become a priority in transplant programs.

Bottom Line:

Behavioral alcohol use disorder therapy improves access to liver transplant waitlisting in patients with alcohol-associated liver disease undergoing early transplant evaluation, but it does not independently predict alcohol relapse before or after transplantation. Efforts should focus on expanding equitable access to behavioral therapy while continuing comprehensive multidisciplinary assessment of relapse risk.