Alcohol-associated liver disease is now the single most common reason Americans need liver transplants — and one of the most vexing challenges in transplant medicine has always been the risk that patients relapse into heavy drinking after surgery, threatening the transplanted organ and potentially making them ineligible for future transplantation. A landmark study published June 3, 2026 by Mayo Clinic researchers in the Liver Transplantation journal may have found a breakthrough answer to that challenge.

The study, led by Dr. Channa Jayasekera, Mayo Clinic transplant hepatologist, describes PACT — Preventing Alcohol-related Complications after Transplantation — a first-of-its-kind multidisciplinary proactive protocol that eliminated heavy alcohol relapse entirely among the 21 patients who completed it within the first year. The historical relapse rate in comparable populations has been approximately 25 percent.

"The results were greater than we expected," said Dr. Jayasekera. "Among the 21 patients in the study, none relapsed to heavy alcohol use within one year. Although this was a small cohort, having no relapses is incredibly encouraging that we have found an effective intervention."

How PACT Works — and Why It's Different

The key philosophical shift in PACT is that it is proactive rather than reactive. Traditional post-transplant care for alcohol-associated liver disease has typically monitored patients after surgery and intervened only after a relapse occurred. PACT reverses that approach entirely, beginning structured addiction treatment immediately after the transplant rather than waiting to see if a patient drinks.

The PACT protocol combines four elements: anticraving medication (pharmacotherapy for alcohol use disorder), frequent structured patient follow-up appointments, alcohol metabolite testing to objectively monitor sobriety, and coordinated care from a multidisciplinary team including transplant hepatologists, surgeons, addiction medicine counselors, psychiatrists, and pharmacists. The team-based model is designed to provide constant structured support during the first critical year, when relapse risk is highest.

This matters urgently because many patients who need liver transplants for alcohol-associated liver disease arrive in life-threatening condition without time to complete traditional pre-transplant sobriety requirements. They receive the transplant as a lifesaving measure — and the post-transplant period becomes the primary window for establishing stable recovery.

"Patients who relapse after transplant face a higher risk of serious health complications and may not be eligible for another liver transplant," the Mayo team noted, underscoring why preventing that first relapse is so clinically consequential.

Implications for a Growing National Problem

Alcohol-associated liver disease has been on a relentless upward trajectory in the United States. The COVID-19 pandemic accelerated alcohol use disorder across age groups and demographics, and alcohol-related liver hospitalizations and deaths have not returned to pre-pandemic levels. Liver transplant programs nationally have grappled with how to ethically and effectively allocate scarce livers while giving patients with alcohol-associated disease the best chance at long-term sobriety.

PACT's results, while from a small initial cohort of 21 patients, demonstrate what is possible when addiction treatment is integrated fully into the transplant care pathway from day one. The Mayo team is now expanding the protocol and plans to publish follow-up data from a larger cohort. Other transplant centers will be watching closely: if the zero-relapse result holds in larger studies, PACT could become a national standard of care.

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Frequently Asked Questions

Q: What is the PACT protocol?

A: PACT (Preventing Alcohol-related Complications after Transplantation) is a Mayo Clinic proactive post-liver transplant program combining anticraving medication, frequent follow-up, alcohol metabolite testing, and coordinated multidisciplinary care.

Q: What were the results?

A: 0% heavy alcohol relapse rate among 21 patients who followed the protocol within one year of liver transplantation, compared to a historical relapse rate of approximately 25%.

Q: Is this available at other hospitals?

A: Currently, PACT has been developed and studied at Mayo Clinic in Arizona. The team is expanding the cohort. Other transplant centers may implement similar protocols based on these results.

Q: What counts as "heavy alcohol use" in this study?

A: Binge drinking (5+ drinks per occasion for men, 4+ for women) or drinking alcohol more than 4 days per week.