A Rational Approach to Liver Transplantation for the Alcoholic Patient

Predictive factors for alcoholic relapse in the selection of alcohol- dependent persons for hepatic transplant

“…13,14 Early experience suggests that women are more likely to have this diagnosis because they seem to be more vulnerable to liver injury caused by alcohol in the absence of alcohol dependence. Alcohol abuse, which is by the few available accounts 13,15 a prognostically more optimistic diagnosis, has been variously defined in different iterations of standard criteria and offers considerably less precision in its use.…”

“…13 Several of the currently published outcome studies either fail to make this distinction or, having made it, do not account for it in their assessments of outcome, rendering their outcome data less precise ( Table 2). Although alcohol dependence has significant relapse potential, the prognosis for relapse in most instances of active drug abuse is considerably worse for most persons addicted to drugs other than to alcohol.…”

“…23 The second may also have the same risks and include the possibility of impulsive, near fatal acts such as an overdose of acetaminophen and ethanol, resulting in catastrophic liver injury necessitating liver transplant consideration. 24,25 Antisocial personality tends to be a predominantly male diagnosis and may in- 38 1 0 0 0 Bird (1990) 46 1 0 0 0 Howard (1994) 49 1 1 0 0 Knechtle (1992) 14 1 1 1 0 Gish (1993) 28 1 1 1 0 Osorio (1993) 47 1 1 1 0 Beresford (1990) 11 1 1 1 1 Lucey (1992) 35 1 1 1 1 Lucey (1997) 37 1 1 1 1 Everson (1997) 36 1 1 1 1…”

Treatment of the postoperative alcoholic liver transplant recipient with other addictions

“…In addition, the courts pressed addiction experts to develop reasonable and rational selection criteria on which to base clinical decisions in evaluating alcoholic transplant candidates. 7,8 …”

Transplantation for alcoholic liver disease: The ethical issues

“…Indeed, in one study of 267 patients with apparent ALD, 74% were determined to be alcohol dependent, 13% qualified for the lesser diagnosis of alcohol abuse, and 13% failed to meet any psychiatric diagnosis for alcoholism. 3 How, then, do Moss and Siegler propose to distinguish those among this group who could and should have taken steps to prevent liver failure from those who may have had no reason to suspect that their drinking would lead to liver failure? Would they, in the interest of fairness, propose that clinicians undertake long and costly investigations into each individual' s history, employing private investigators and lie detectors?…”