Factors Influencing the Prognostic Assessment of Patients with End-Stage Alcohol-Associated Liver Disease before Liver Transplantation

INTRODUCTION: Although alcohol-associated liver disease (ALD) is a leading cause of liver transplantation, most patients with ALD are never evaluated. This study aims to investigate the prognostic assessment process of medical professionals often involved in treating patients with ALD. We wanted to assess the possible effect of disease understanding, stigmatization, experience in transplantation, and addiction medicine on the liver transplantation evaluation process. METHODS: The study was conducted as an anonymous online survey. In total, 407 health professionals were included in the study (291 medical doctors, 86 nurses, and 30 psychologists). The participants were invited to review five cases of potential liver transplantation candidates and assess the prognostic outcome ("positive control," "negative control," "missing illness insight," "missing social support," "abstinence under 6 months"). RESULTS: Mean prognostic assessment scores were significantly different between the cases, with abstinence under 6 months being graded the highest, followed by lack of social support and lack of disease insight. We fitted a linear regression to model the influence of stigmatization, individual alcohol use, disease understanding, and experience in transplant and addiction medicine on the appraisal of each case. All models were significant (Model 1: R = 0.201, p = 0.005; Model 2: R = 0.312, p < 0.001; Model 3: R = 0.291, p < 0.001; Model 4: R = 0.283, p < 0.001; Model 5: R = 0.285, p < 0.001). All factors had a significant effect on one or more of the cases. CONCLUSIONS: The findings suggest that patient and evaluator characteristics significantly impact the prognostic assessment process of patients with ALD and highlight potential biases when assessing the prognosis.