# Project 2-Optimization of Post-Transplant care via Biomarkers and Behavioral Interventions

> **NIH NIH P50** · JOHNS HOPKINS UNIVERSITY · 2024 · $359,527

## Abstract

PROJECT SUMMARY
Project 2 of the Johns Hopkins DELTA Center for Alcohol Research focuses on studying and implementing
evidence-based alcohol use disorder (AUD) interventions in the post-transplant setting. Alcohol-associated
liver disease (ALD) is the leading indication for liver transplants (LT) in the United States. Our group and others
have demonstrated comparable survival outcomes between recipients of early (ELT; <6-month abstinence)
versus standard liver transplants (SLT; ≥6-month abstinence) for severe ALD. Therefore, we have advocated
that transplant programs waive the arbitrary “6-month rule” to promote equity of access to LT for all patients
with ALD. However, return to alcohol use remains a considerable concern for both ELT and SLT recipients; up
to 40% report alcohol relapse and have 22% lower absolute cumulative survival by three years after LT.
Furthermore, while most transplant programs have historically mandated or enforced pre-LT alcohol treatment,
post-LT treatment services have received far less attention. We conducted a randomized controlled trial (RCT)
during the previous funding cycle to assess technology-assisted, non-traditional AUD treatments integrated
within routine clinical care during post-LT Year 1. The RCT initially encountered delays due to the COVID-19
pandemic. The trial’s progress has been promising since then, though it has also raised additional salient
questions related to AUD treatment among LT recipients: Do LT-specific factors like surgical complications
affect recipients’ engagement with alcohol treatment services? Does the addition of AUD pharmacotherapy by
LT clinicians promote or discourage patient participation in concurrent psychosocial interventions (PSI)? How
can transplant programs provide continued addiction support beyond the early post-LT period? The next phase
of Project 2 will answer these and other questions related to the post-LT delivery of alcohol treatment services
through a combination of observational studies and intervention trial that builds on our lessons learned during
the previous funding cycle. The specific aims are (1) to ascertain the impact of pre- and post-LT factors on
AUD treatment engagement, (2) to quantify the effect of AUD pharmacotherapy on participation in post-
transplant PSI, and (3) to assess the benefit of peer support specialists on long-term post-LT alcohol
outcomes. The proposed studies will systematically examine early and long-term approaches to increase LT
recipients’ participation in AUD treatment, decrease alcohol relapse risk, and improve overall survival.
Compared to co-located hepatology/addiction clinical models, which face many systems-level obstacles toward
broad dissemination, our interventions are desirable given their greater ease of implementation. Our work will
hold the potential to maximize the benefits of a scarce organ resource for society and improve the overall
cost/benefit balance of LT for patients with severe ALD.

## Key facts

- **NIH application ID:** 10741445
- **Project number:** 2P50AA027054-06
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Po-Hung (Victor) Chen
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $359,527
- **Award type:** 2
- **Project period:** 2019-02-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10741445

## Citation

> US National Institutes of Health, RePORTER application 10741445, Project 2-Optimization of Post-Transplant care via Biomarkers and Behavioral Interventions (2P50AA027054-06). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10741445. Licensed CC0.

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