Updated October 13, 2021, to include video, "Severe alcoholic hepatitis: Asking the tough questions."

By Dan Carrigan

Music is Steven Bennett’s passion. The talented guitar player enjoys playing classical guitar, country, jazz and blues.

The Fairfax County native enjoys sharing his talent with others. He’s a guitar teacher at a music shop — using his love of music to instruct nearly two dozen students. Some of his students are adults – even senior citizens — while many of the youngsters are picking up a guitar for the very first time.

“The real little kids bring me back to when I started playing,” Steven said.

He’s also played gigs — from concert venues and weddings to local charity concerts raising funds for the treatment and cure of various health conditions.

“I’ve always done benefits, never thinking I’d be the one needing that care,” Steven said.

But when he did, he went to VCU Medical Center. The 32-year-old had pushed his liver to failure due to alcohol abuse.  Steven desperately needed a liver transplant.

Second chances

As part of an ongoing effort to provide holistic transplant care to patients, the VCU Health Hume-Lee Transplant Center began a unique program to transplant patients like Steven who suffer from severe alcoholic hepatitis — a condition that often disqualifies patients at other centers.

A form of alcohol-related liver disease (ARLD), severe alcoholic hepatitis may occur quickly following heavy, short-term alcohol use. It differs from cirrhosis, which has many causes — one of which is long-term use of alcohol. Transplant centers often require a sobriety period — usually 6 months — before a patient can receive a liver transplant.

The VCU Health program provides addiction treatment to patients with severe forms of alcoholic hepatitis. The program aims to transplant those patients with severe illness whose life expectancy is just a matter of weeks. 

“These are usually young people who've, admittedly, made mistakes with alcohol, and unfortunately for them, are now facing the consequences,” said Dr. David Bruno, surgical director of adult and pediatric liver transplantation at the VCU Health Hume-Lee Transplant Center.

“By working with addiction medicine specialists, alcohol counselors, social workers, hepatologists and surgeons, we're able to give some of these patients a second chance. This is a really unique approach we’re taking here at VCU Health.”

Care for vulnerable patients

It’s a sea change in the world of liver transplantation. Traditionally, transplant centers in the United States have declined to transplant patients with less than six months’ sobriety. This protocol almost immediately disqualifies severe alcoholic hepatitis patients. Their liver failure comes on suddenly, without warning, allowing little time for alcohol recovery.

“We're asking questions about that, coupled with recent research, which shows that in select patients with less than six months of sobriety, they do just as well as people with five years of sobriety. What we're doing here is we're asking the next question: Can we transplant these people to give them the power to change their lives? I think we’re answering it.”

Dr. Bruno explains that each patient at Hume-Lee receives a full evaluation and consultation with the center’s multidisciplinary team to ensure they are qualified for transplant. This is in line with their evaluation of patients with other conditions that may exclude them from transplant at other centers, such as those who are older, are obese or suffer from complex cardiovascular conditions.

“These are really the most vulnerable patients,” Bruno said. “These people who need lifesaving organs don’t fit into a box. Everyone is different, and they deserve a chance. Not all transplant centers have the team or are capable of thinking and operating this way.”

Holistic approach to fighting addiction and offering second chances

To treat patients suffering from addiction, Hume-Lee developed a program with addiction medicine specialists at VCU Health. It also partnered with organizations such as Journey House, a Richmond-based addiction recovery organization.

For patients on the path to one day needing a liver transplant, the VCU Health team connects the patient with the appropriate resources and care. This may include inpatient rehabilitation, outpatient counseling at VCU Health’s MOTIVATE Clinic, support groups or community resources.

“We work to get rid of any barriers to treatment, making sure it is available to them and personalized,” said Dr. Albert Arias, associate division director of addiction psychiatry at VCU, who is an addiction treatment expert and researcher. “We want to make sure patients are surrounded by a lot of support and resources.”

For patients who urgently need a liver transplant, the team performs appropriate behavioral health treatment while implementing strict protocol ensuring the patient has adequate support from family and friends and the commitment to continue addiction treatment post-transplant. VCU Health also requires the patient to sign a contract agreeing that they’ll never drink again.

Following transplant, the patient will need a variety of treatments. This includes inpatient or intense outpatient therapy. Transplant and behavioral health teams follow the patient closely post-transplant to ensure health, safety and care coordination for additional resources. This team also uses telehealth and provides virtual behavioral health appointments.

Patients are all followed by a dedicated transplant coordinator, who manages their transplant care and coordination.

“Our team works to establish a strong rapport with these patients as we support them days, months and years following their transplant,” said Nicky Keller, senior liver transplant coordinator at VCU Health Hume-Lee Transplant Center. “Steven is a star patient.”

Steven gets the call

From his hospital bed, with his life on the line, Steven was told there was a match. He’d receive a new liver. He began to cry.

“It’s a huge blessing, but someone had to go through one of the worst possible things, losing a family member or a child, for me to live. And I put myself in this situation.”

With the support of his addiction medicine team, Steven underwent surgery to receive his new liver. After his transplant, he went to VCU Health’s MOTIVATE clinic for counseling and group support sessions.

Now home in Chantilly, Steven attends support groups in northern Virginia.  He is also followed by VCU Health clinical and behavioral health professionals.

Grateful for support

Reflecting on his journey and recovery — both from surgery and alcohol use — Steven touts the support he received from his family, friends and health care team. He doesn’t know why he drank, but that’s behind him now.

“Before my liver failed, I wanted to get better. I just didn’t know how.”

To aid in his recovery, Steven was visited in the hospital by a VCU Health music therapist, who would sing and play guitar for him. With his strength improving, Steven progressed to playing guitar and ukulele with the staff member.

“That got me through everything,” Steven said. 

Describing his care team, family and friends, Steven said, “They gave me life. They gave me a reason to live. What words can you use for the respect and love you have for somebody? Every single person. They’re the greatest people in the world. There is no judgement, you feel that.”

And how is Steven feeling?

“I feel good,” Steven said. “And that’s a feeling I haven’t had in a long time. Just to wake up every day and feel good. It’s just amazing.”

Listen to our podcast on Hume-Lee's Severe Alcoholic Hepatitis Transplant Program. 

To learn more about liver transplantation at the VCU Health Hume-Lee Transplant Center, check out this video featuring Dr. Bruno.

Sign Up for Transplant E-Newsletter

This article originally published December 18, 2020.