Background Many concerns about liver transplantation in alcoholic patients are related to the risk of alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit was formed within the Liver Transplant Centre for the management of alcoholic patients affected by end-stage liver disease and included in the waiting list for transplantation. We evaluated retrospectively the impact of the Alcohol Addiction Unit on alcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration of alcohol abstinence before transplant was evaluated as well. Methods Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation. Clinical evaluation and management of alcohol use in these patients was provided by psychiatrists with expertise in addiction medicine not affiliated to the Liver Transplant Centre before 2002 (n=37; group A), or by the clinical staff of the Alcohol Addiction Unit within the Liver Transplant Centre starting from 2002 (n=55; group B). Results Group B, as compared to group A, showed a significantly lower prevalence of alcohol recidivism (16.4% vs. 35.1%; p=0.038) and a significantly lower mortality (14.5% vs. 37.8%; p=0.01). Furthermore, an analysis of group B patients with either ≥6 months or <6 months of alcohol abstinence before transplantation showed no difference in the rate of alcohol recidivism (21.1% vs. 15.4%; p=ns). Conclusions The presence of an Alcohol Addiction Unit within a Liver Transplant Centre reduces the risk of alcohol recidivism after transplantation. A pre-transplant abstinence period <6 months might be considered, at least in selected patients managed by an Alcohol Addiction Unit.

Most of the patients who seek medical consultation for gastrointestinal problems show an associated affective disorder. These patients should be managed by a team including gastroenterologists, psychologists and/or psychiatrists, or by a gastroenterologist having expertise in the treatment of psychological disorders.

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