Abusive drinking after liver transplantation is associated with allograft loss and advanced allograft fibrosis

Abstract

In patients who undergo liver transplantation for alcoholic liver disease (ALD), alcohol relapse is common. A return to abusive or excessive drinking likely decreases overall survival; however, the effects of alcohol use on allograft outcomes and histopathology are less well defined. We reviewed all cases of liver transplantation with ALD as an indication between January 1, 1995 and December 31, 2007. Allograft outcomes and histopathological results were compared for patients who relapsed into alcohol use and patients who maintained abstinence. Three hundred patients who underwent transplantation for ALD during this period survived at least 1 year, and 48 (16.0%) relapsed into alcohol use that came to clinical attention. The pattern of relapse was a single event for 10 patients (20.8%), intermittent relapses for 22 patients (45.8%), and continuous heavy drinking for 16 patients (33.3%). Continuous heavy drinking was associated with allograft loss in a univariate Cox proportional hazards analysis [hazard ratio (HR) 5 2.43, 95% confidence interval (CI) 5 1.26-4.68, P 5 0.008] and in a multivariate Cox proportional hazards regression (HR 5 2.57, 95% CI 5 1.32-5.00, P 5 0.006). A matched-pair analysis that controlled for the hepatitis C virus status and the time to biopsy compared the results of allograft histopathology for patients who relapsed into alcohol use and patients who maintained abstinence. Significant steatosis [odds ratio (OR) 5 3.46, 95% CI 5 1.29-9.31, P 5 0.01], steatohepatitis (OR 5 6.2, 95% CI 5 1.70-22.71, P 5 0.006), and advanced (stage 3 or higher) fibrosis (OR 5 23.18, 95% CI 5 3.01-177.30, P 5 0.003) were associated with alcohol relapse. In conclusion, alcohol relapse after liver transplantation (particularly heavy drinking) is associated with decreased graft survival and advanced allograft fibrosis.

Addiction specialist's role in liver transplantation procedures for alcoholic liver disease

“…Importantly, post-operatively between 30% and 50% of the patients relapse in any alcohol use and 20% to 25% of them relapse in heavy alcohol use [8] . Relapse in long during and excessive alcohol use after LT increases the risk on allograft damage and mortality [9,10] . Thus both from the point of view of patient safety and within the context of chronic low allograft availability, efforts are justified towards using valid screening procedures to identify the most suitable candidates and offering treatment to help patients to (re) gain and maintain sobriety [7] .…”

Management of alcohol recurrence before and after liver transplantation

“…The probability of long-term sobriety becomes robust only after 5 years of sustained abstinence [19][20][21].…”

“…Alcohol consumption after transplant can compromise the graft, predispose to medical non-adherence to immunossupression or foster rejection (61%) through harmful alcohol intake [6][7][8]21,25,26].…”

“…Detection of factors before and after LT that could predict relapse to alcoholism post-LT are not available but the target detection of ''relapse predict factors'' could benefit sobriety and adherence with medications and appointments [21,23].…”

Liver Transplantation for Severe Alcoholic Hepatitis Crosses the Atlantic

“…These views may be expressed as concern that patients without extended sobriety will experience poor outcomes due to alcohol relapse. However, while patients with alcoholic liver disease who undergo transplantation are at risk of alcohol relapse, and severe alcohol relapse is associated with liver and other personal injuries, the vast majority of alcoholic patients have excellent outcomes after liver transplantation (7,8). These results have been achieved in transplant programs that apply stringent selection criteria including requiring a fixed interval of abstinence.…”