BackgroundAlcoholic cirrhosis is an indication for 40% of liver transplantations (LT) in Europe. In most centers, 6 months of abstinence is required before listing. However, alcohol recidivism is quite high after LT, and approximately 20–25% of recipients with ALD resume harmful drinking, resulting in liver insufficiency, which casts doubt on the 6-months rule as a reliable marker of abstinence maintenance after LT.Material/MethodsWe analyzed data on patients who underwent orthotopic LT in Marie Curie Hospital, Szczecin, Poland, from 2000 to 2015 due to alcoholic or cryptogenic cirrhosis. Every ALD patient met the 6-month abstinence requirement. Alcohol recidivism has been studied based on a history of alcohol abuse taken from the patients or from their relatives, and in case of denial, on laboratory tests for alcohol abuse. Five patterns of recidivism were distinguished: death, constant heavy drinking, heavy drinking with abstinence attempts, occasional laps, and a single episode of alcohol intake. The analysis of survival was performed according to the Kaplan-Meier method. Patient survival rates in ALD recipients vs. non-ALD recipients were compared using the log-rank test.ResultsAlcohol recidivism was finally evaluated in 109 patients: 81 males and 28 females, with a median age of 53.3 years (range 30–66). Harmful drinking was discovered in 16 patients (14.7%), including seven deaths due to alcoholic hepatitis. Sporadic or episodic drinking was found in 29 patients (27%). In heavy drinkers, the abstinence period after transplantation was significantly shorter and patients were younger than the average (median age 43.8 years). Women break abstinence faster than men and are at greater risk of liver insufficiency. Five, 10 and 15-year survival in the ALD group was superior in comparison with non-ALD group, but differences did not reach statistical significance (p=0.066, p=0.063, p=0.075, respectively).ConclusionsThe prognostic value of a 6-month abstinence period before transplantation is rather low as it does not predict sobriety after transplantation. However, only a minority of such patients drink harmfully. Survival in ALD recipients tends to be better in comparison with survival in the other etiologies. Younger women dependent on alcohol shortly before LT are at greatest risk of recidivism.
BackgroundThere is a worldwide increase in use of liver transplantation (LT) for treatment of hepatocellular carcinoma (HCC). We analyzed our experience with LT for HCC to determine long-term and recurrence-free survival, accuracy of imaging diagnosis of HCC compared to the explant pathology, recurrence rate of HCC, and predictors of recurrence.Material/MethodsThe whole explant was examined by the same pathologist and compared with the baseline diagnosis established according to clinical, laboratory, and radiological data. A group of patients with pathologically confirmed HCC was characterized, with special attention to etiology, survival, recurrence, and diagnostic accuracy of imaging techniques.ResultsAmong 718 patients transplanted from 2000 to 2018 in our center, HCC was found in 166 explanted livers. In 42 cases the clinical diagnosis of HCC was not accurate, being either false positive or negative; however, the specificity and sensitivity of CT/MRI in HCC recognition was 97.87% and 88.24%, respectively. Five- and 10-year survival was 81.27% and 66.57%, respectively, and it was inferior to the overall survival. The recurrence rate was 9.6% with a median time to recurrence of 14 months and a median survival time of 9 months. Poor differentiation of HCC and HCV etiology of the baseline disease, but not previous DAA treatment, were the risk factors of HCC recurrence.ConclusionsAdherence to strictly defined selection criteria for LT in HCC patients guarantees the success of LT in HCC treatment.
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