Table 4:

Listing criteria and program components for LT for AH

	Primary criteria	Secondary considerations
Alcohol associated hepatitis assessment	First presentation with decompensated AH	No prior liver related hospitalization
	Absence of severe medical comorbidities	Frailty, debility and multiorgan failure No other contraindications to LT
	Non-response or ineligible to medical therapy.	Contraindications: disease severity, multi organ failure, infection, renal failure and low likelihood for response Consider non-responders using Lille score >=0.45 or worsening of liver function by d4 or d7 Monitor for signs of recovery after listing.
Alcohol use disorder assessment	Establish acceptable risk of relapse as assessed by a multidisciplinary psychosocial team composed of a social worker and at least one addiction specialist.	Not intubated Consider independent team of specialists in addiction, social workers, and mental health providers Ideally first member of LT team to evaluate Consider independent mechanisms for regional or local review
	Direct assessment of patient possible by addiction specialist	i.e. not intubated or floridly encephalopathic.
	A maximum of 1 prior failed attempt at rehabilitation.
	Lack of other active substance use/dependency or active untreated psychiatric disorder
	Acceptance of diagnosis/insight
	Commitment of patient/family to sobriety and formalized agreement to adhere to lifelong total alcohol abstinence	Establish contract and participation in addiction rehabilitation following transplant
	Presence of close, supportive family members or caregivers
Committee Decision making	Consensus of paramedical and medical staff	Consider blinded voting in committee deliberations Consider absolute consensus
Program components	Transparency in selection process	LT reserved for patients with a favorable prognosis for long-term abstinence.
	Independent psychosocial assessment	Mental health professional with addiction background/training Mental health professional familiar with transplant process
	Structured Post LT follow up mechanism in place	Documentation of AUD management plan pre and post-LT Dedicated addiction specialist/mental health professional for longitudinal management Commitment for regular monitoring for alcohol use Phosphatidylethanol (PEth), Urinary ethyl glucuronide Structured monitoring program for post-transplant alcohol relapse and, in the event of alcohol relapse, provide resources to assist the patient in recovery
	Team mental health	Consider formal addiction educatio for transplant staff