During Liver Awareness Month, join Dr. Rachel Hogen to identify the implications and consequences of alcohol use disorder, explore the multi-disciplinary program at Tampa General Hospital to help patients with alcohol use disorders, and to describe the use of liver transplant in this disorder.
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Alcohol Use Disorder And Transplantation
Featuring:
Rachel Hogen, MD
I am an abdominal organ transplant surgeon and hepatobiliary surgeon at Tampa General Hospital. I am originally from Los Angeles, California. I did my general surgery and abdominal transplant training at the University of Southern California.
Transcription:
Prakash Chandran: Alcohol use disorder is a chronic disease characterized by uncontrollable drinking of alcohol common treatments include options such as therapy, medication and transplantation. In this CME, we will be discussing what Tampa General Hospital offers for this disorder. me today is Dr. Rachel Hogen, a transplant surgeon at Tampa General Hospital.
Welcome to MD Cast by Tampa General Hospital, a go-to listening location for specialized physician to physician content and a valuable learning tool for world class healthcare. I am your host Prakash Chandran. So Dr. Hogen really great to have you here today. Thank you so much for joining us. I wanted to get started by asking why is alcohol use disorder so important?
Rachel Hogen, MD: Well, thank you for having me today precaution. It's an honor to be here. Alcohol use disorder is a huge societal problem and it affects the lives of many of our patients, unfortunately more than 85,000 deaths a year in the United States are directly attributed to alcohol use. And the annual economic cost of alcohol use is estimated to be about 250 billion. So it's a significant societal problem. Approximately one in 10 deaths among working age adults also result from excessive drinking.
And unfortunately the pandemic has worsened this, so alcohol sales, alcohol consumption, mortality and complications related to alcohol use have all Skyrocketed during the pandemic. And more concerning is that this trend has been particularly notable among young adults. And as we know, alcohol use disorder is classified as a mental health disorder under the DSM five, which is the psychiatric classification system. So it's our responsibility as physicians and a health system to know how to treat and address this growing problem.
Prakash Chandran: Yeah, absolutely. And you started to allude to this already, but I wanted to ask you more specifically, what exactly are the health implications of alcohol use disorder for patients?
Rachel Hogen, MD: So excessive alcohol consumption is the third leading cause of preventable death in the United States. So, it can lead to very severe consequences for patients, but it can also manifest negatively in almost any organ system of the body. So excessive drinking can manifest as, high blood pressure or sleep apnea or gastrointestinal reflux or psychological disturbances such as anxiety and depression and even liver failure and death.
Prakash Chandran: So for the patients that might be experiencing some of these that you just mentioned, are there programs that Tampa General Hospital has to help these patients?
Rachel Hogen, MD: At the Tampa General Transplant Institute, we comprehensively manage all patients with alcohol use disorder and have specific resources for those patients with alcohol use disorder and liver disease. We have a multiple disciplinary team in our alcohol use disorder, clinic of hepatologists, psychologists, and social workers. And for those patients that require liver transplantation we maintain continuative care throughout this clinic to help patients stay sober after liver transplantation and return to their normal life.
Prakash Chandran: Yeah. So you mentioned that liver transplantation how exactly does it play a role in this disorder?
Rachel Hogen, MD: Liver transplantation is a life saving surgery for those patients who progress to liver failure from alcohol use. However, it's just one piece of the treatment algorithm and definitely doesn't work in isolation. Luckily at Tampa General Hospital, we offer a comprehensive care for patients with alcohol use disorder, with significant psychological services and addiction management to help patients stay sober while they await transplant and thereafter.
Prakash Chandran: And typically, what are the outcomes that you see with people that actually go through with the transplant?
Rachel Hogen, MD: We've been very fortunate to have excellent outcomes at our program. We have a alcohol relapse rate after liver transplantation of about 11% which is much lower than reported rates in the literature and other us and European centers. And we also have excellent, liver transplant outcomes in this population with the estimated one year survival rate of 94%. And these great outcomes really speak to the hard work of our multi multidisciplinary team to make sure that the patient not only has excellent medical and surgical outcomes, but the psychological support to stay sober and to make meaningful changes in their personal lives.
Prakash Chandran: Okay. Awesome. So when it comes to a liver transplant, at what stage is that considered? Is that kind the last, method of treatment that someone leverage when they have alcohol use disorder?
Rachel Hogen, MD: Liver transplantation really comes into play at different stages, of the disorder depending on the patient's presentation. So, some patients with alcohol use disorder unfortunately will manifest as acute liver failure after an episode of binge drinking or a weekend of severe heavy drinking. And unfortunately they'll actually progress to liver failure and present to the hospital in liver failure. that's an acute emergency that we use liver transplantation as a life saving measure.
Other patients have prolonged alcohol use that leads to more chronic liver failure that we call cirrhosis. And those patients start to develop negative systemic consequences from cirrhosis to the point that they need transplantation in those more stable patients, we have more time to, prepare them for liver transplantation and give them the support they need prior to liver transplantation. To make sure that they have a good outcome. But liver transplantation can really be used across a spectrum of presentations for alcohol use disorder with good outcomes.
Prakash Chandran: Well, that's good to know. I had a more basic question. I think that, especially, as you mentioned during the pandemic, lot of people turn to alcohol to just kind of soothe their pain, based on the number of different things that they were experiencing and to cope with a lot of different things. How can one identify whether they might have an issue and how can they go about seeking help?
Rachel Hogen, MD: So I think for patients if they find themselves drinking every day, if they find themselves waking up in the morning and needing a drink, if they find themselves relying on alcohol to function or withdrawing from alcohol, if they go several days without drinking. Or if they find themselves struggling in their daily lives or noticing new unusual symptoms or health complaints that they didn't have before, they should consider whether they're drinking could be playing a role. And they should first seek help from their primary care physician or a psychologist. And from there can be directed, to more specific treatments if they're needed.
Prakash Chandran: So just before we close here, there's always a question that I always like to ask. And that is given all your years of experience as a transplant surgeon. What is one thing that you just know to be true that you wish more people knew before they either turned to alcohol or came in to see you?
Rachel Hogen, MD: I know that everyone deserves a second chance and that I know that everyone can fix their lives if given the right resources and the right help. Even if Patients feel like their situation is hopeless. We have really turned the lives around of so many patients here with the resources that we have here. And I found it's very difficult to predict, which patients will relapse and which ones won't some of the most hopeless situations we've, had a good outcome with. So, I think, any patient deserves help.
Prakash Chandran: Yeah. And I think the takeaway there is just understanding that people aren't alone in this, that, you know, everyone suffers. I mean, you threw out some pretty staggering statistics up at the top. And the wonderful thing. Is that there are so many different resources, like the ones mentioned at Tampa General Hospital that can help you. So if you feel like you wanna reach out to someone or you're struggling with this alone, it's always best to reach out. Wouldn't you say?
Rachel Hogen, MD: Yes, that's completely true. Yes. A hundred percent agree with that patients are definitely not alone and we have a lot of resources to help people here at Tampa General. Yeah.
Prakash Chandran: Okay, fantastic. Well thank you so much for joining us today. Dr. Hogen, I really appreciate your time.
Rachel Hogen, MD: Yeah. Thank you, Prakash. Thank you for having me.
Prakash Chandran: That was Dr. Rachel Hogen, a transplant surgeon at Tampa General Hospital. Thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. to collect your CME. Please click on the link in the description. You can also visit tgh.org/cme for other CME opportunities, including live webinars on demand, videos, and local events offered to you by Tampa General Hospital. Thanks again for listening. My name's Prakash Chandran, be well.
Prakash Chandran: Alcohol use disorder is a chronic disease characterized by uncontrollable drinking of alcohol common treatments include options such as therapy, medication and transplantation. In this CME, we will be discussing what Tampa General Hospital offers for this disorder. me today is Dr. Rachel Hogen, a transplant surgeon at Tampa General Hospital.
Welcome to MD Cast by Tampa General Hospital, a go-to listening location for specialized physician to physician content and a valuable learning tool for world class healthcare. I am your host Prakash Chandran. So Dr. Hogen really great to have you here today. Thank you so much for joining us. I wanted to get started by asking why is alcohol use disorder so important?
Rachel Hogen, MD: Well, thank you for having me today precaution. It's an honor to be here. Alcohol use disorder is a huge societal problem and it affects the lives of many of our patients, unfortunately more than 85,000 deaths a year in the United States are directly attributed to alcohol use. And the annual economic cost of alcohol use is estimated to be about 250 billion. So it's a significant societal problem. Approximately one in 10 deaths among working age adults also result from excessive drinking.
And unfortunately the pandemic has worsened this, so alcohol sales, alcohol consumption, mortality and complications related to alcohol use have all Skyrocketed during the pandemic. And more concerning is that this trend has been particularly notable among young adults. And as we know, alcohol use disorder is classified as a mental health disorder under the DSM five, which is the psychiatric classification system. So it's our responsibility as physicians and a health system to know how to treat and address this growing problem.
Prakash Chandran: Yeah, absolutely. And you started to allude to this already, but I wanted to ask you more specifically, what exactly are the health implications of alcohol use disorder for patients?
Rachel Hogen, MD: So excessive alcohol consumption is the third leading cause of preventable death in the United States. So, it can lead to very severe consequences for patients, but it can also manifest negatively in almost any organ system of the body. So excessive drinking can manifest as, high blood pressure or sleep apnea or gastrointestinal reflux or psychological disturbances such as anxiety and depression and even liver failure and death.
Prakash Chandran: So for the patients that might be experiencing some of these that you just mentioned, are there programs that Tampa General Hospital has to help these patients?
Rachel Hogen, MD: At the Tampa General Transplant Institute, we comprehensively manage all patients with alcohol use disorder and have specific resources for those patients with alcohol use disorder and liver disease. We have a multiple disciplinary team in our alcohol use disorder, clinic of hepatologists, psychologists, and social workers. And for those patients that require liver transplantation we maintain continuative care throughout this clinic to help patients stay sober after liver transplantation and return to their normal life.
Prakash Chandran: Yeah. So you mentioned that liver transplantation how exactly does it play a role in this disorder?
Rachel Hogen, MD: Liver transplantation is a life saving surgery for those patients who progress to liver failure from alcohol use. However, it's just one piece of the treatment algorithm and definitely doesn't work in isolation. Luckily at Tampa General Hospital, we offer a comprehensive care for patients with alcohol use disorder, with significant psychological services and addiction management to help patients stay sober while they await transplant and thereafter.
Prakash Chandran: And typically, what are the outcomes that you see with people that actually go through with the transplant?
Rachel Hogen, MD: We've been very fortunate to have excellent outcomes at our program. We have a alcohol relapse rate after liver transplantation of about 11% which is much lower than reported rates in the literature and other us and European centers. And we also have excellent, liver transplant outcomes in this population with the estimated one year survival rate of 94%. And these great outcomes really speak to the hard work of our multi multidisciplinary team to make sure that the patient not only has excellent medical and surgical outcomes, but the psychological support to stay sober and to make meaningful changes in their personal lives.
Prakash Chandran: Okay. Awesome. So when it comes to a liver transplant, at what stage is that considered? Is that kind the last, method of treatment that someone leverage when they have alcohol use disorder?
Rachel Hogen, MD: Liver transplantation really comes into play at different stages, of the disorder depending on the patient's presentation. So, some patients with alcohol use disorder unfortunately will manifest as acute liver failure after an episode of binge drinking or a weekend of severe heavy drinking. And unfortunately they'll actually progress to liver failure and present to the hospital in liver failure. that's an acute emergency that we use liver transplantation as a life saving measure.
Other patients have prolonged alcohol use that leads to more chronic liver failure that we call cirrhosis. And those patients start to develop negative systemic consequences from cirrhosis to the point that they need transplantation in those more stable patients, we have more time to, prepare them for liver transplantation and give them the support they need prior to liver transplantation. To make sure that they have a good outcome. But liver transplantation can really be used across a spectrum of presentations for alcohol use disorder with good outcomes.
Prakash Chandran: Well, that's good to know. I had a more basic question. I think that, especially, as you mentioned during the pandemic, lot of people turn to alcohol to just kind of soothe their pain, based on the number of different things that they were experiencing and to cope with a lot of different things. How can one identify whether they might have an issue and how can they go about seeking help?
Rachel Hogen, MD: So I think for patients if they find themselves drinking every day, if they find themselves waking up in the morning and needing a drink, if they find themselves relying on alcohol to function or withdrawing from alcohol, if they go several days without drinking. Or if they find themselves struggling in their daily lives or noticing new unusual symptoms or health complaints that they didn't have before, they should consider whether they're drinking could be playing a role. And they should first seek help from their primary care physician or a psychologist. And from there can be directed, to more specific treatments if they're needed.
Prakash Chandran: So just before we close here, there's always a question that I always like to ask. And that is given all your years of experience as a transplant surgeon. What is one thing that you just know to be true that you wish more people knew before they either turned to alcohol or came in to see you?
Rachel Hogen, MD: I know that everyone deserves a second chance and that I know that everyone can fix their lives if given the right resources and the right help. Even if Patients feel like their situation is hopeless. We have really turned the lives around of so many patients here with the resources that we have here. And I found it's very difficult to predict, which patients will relapse and which ones won't some of the most hopeless situations we've, had a good outcome with. So, I think, any patient deserves help.
Prakash Chandran: Yeah. And I think the takeaway there is just understanding that people aren't alone in this, that, you know, everyone suffers. I mean, you threw out some pretty staggering statistics up at the top. And the wonderful thing. Is that there are so many different resources, like the ones mentioned at Tampa General Hospital that can help you. So if you feel like you wanna reach out to someone or you're struggling with this alone, it's always best to reach out. Wouldn't you say?
Rachel Hogen, MD: Yes, that's completely true. Yes. A hundred percent agree with that patients are definitely not alone and we have a lot of resources to help people here at Tampa General. Yeah.
Prakash Chandran: Okay, fantastic. Well thank you so much for joining us today. Dr. Hogen, I really appreciate your time.
Rachel Hogen, MD: Yeah. Thank you, Prakash. Thank you for having me.
Prakash Chandran: That was Dr. Rachel Hogen, a transplant surgeon at Tampa General Hospital. Thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. to collect your CME. Please click on the link in the description. You can also visit tgh.org/cme for other CME opportunities, including live webinars on demand, videos, and local events offered to you by Tampa General Hospital. Thanks again for listening. My name's Prakash Chandran, be well.