Medications for Alcohol Use Disorder Among Patients With Severe Alcohol-Related Liver Disease.

Importance: Alcohol-related liver disease (ALD) is the leading indication for liver transplant in the US; however, use of medications for alcohol use disorder (MAUDs) remains very low overall. Few studies have examined the use of MAUDs for patients with severe ALD, and lack of clinical knowledge around the benefits of MAUDs for severe ALD remains a barrier to their use. Objective: To assess the association between use of MAUDs and mortality among patients with severe ALD referred for liver transplant. Design, Setting, and Participants: This retrospective single-center cohort study was conducted at a tertiary referral center among 1309 patients with severe ALD referred for liver transplant between January 1, 2016, and December 31, 2022. Statistical analysis was performed from January 2023 to December 2025. Exposure: Use of MAUDs, including US Food and Drug Administration-approved and off-label treatments. Main Outcomes and Measures: The main outcome was all-cause mortality, as determined by clinical staff and documented in the electronic medical record. Results: This study included 1309 patients (mean [SD] age, 57.1 [10.5] years; 989 men [75.6%]) and had a mean (SD) of 38 (25) months of follow-up. Use of MAUDs for at least 3 months was associated with 6.6% higher 1-year survival (SE, 0.02%) and 18.5% higher 3-year survival (SE, 0.03%). This association persisted in propensity score-adjusted multivariable Cox proportional hazards regression models, independent of Model for End-Stage Liver Disease score, liver transplant status, and other clinical factors (hazard ratio, 0.59; 95% CI, 0.39-0.92). Conclusions and Relevance: In this cohort study, use of MAUDs was associated with improved survival among patients with severe ALD. This finding highlights the need for improved access to MAUDs among patients with severe ALD.