Alcohol Relapse After Liver Transplantation: Younger Women Are at Greatest Risk

Abstract

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.

Alcohol and Liver Function in Women

“…The lack of proper counseling for alcohol use disorder must be addressed, as studies have demonstrated increased risk of relapse of harmful drinking among women with alcohol-related liver disease who received transplants. 24 This increased relapse for women is problematic, as it has been associated with a higher incidence of recurrent disease for women than for men.…”

Nosocomial COVID-19 Infection and Severe COVID-19 Pneumonia in Patients Hospitalized for Alcoholic Liver Disease: A Case Report

“…Prior to admission, she was hospitalized in another local hospital with signs and symptoms suggesting alcoholic hepatitis. These symptoms were jaundice, hepatomegaly, tense ascites, peripheral edema, increased liver enzyme activity with the predominance of aspartate aminotransferase (AST) over alanine aminotransferase (ALT) (AST/ALT ratio >2), high gamma glutamyl transferase (GGT) activity, macrocytic anemia, elevated serum bilirubin, increased serum triglycerides, decreased serum albumin, an elevated white blood cell count, and coagulopathy [ 15 ]. After several days of hospitalization, new symptoms, including fever, dyspnea, and cough, appeared.…”

“…Based on the abdominal ultrasound showing liver steatosis, ascites, and hepatomegaly, as well as the laboratory abnormalities typical for alcoholic liver injury, she was diagnosed with alcoholic hepatitis with liver decompensation. The symptoms were jaundice, hepatomegaly, ascites, peripheral edema, increased aminotransferases with the predominance of AST (AST/ALT ratio >2), high GGT activity, macrocytic anemia, elevated serum bilirubin, increased serum triglycerides, decreased serum albumin, an elevated WBC count, and coagulopathy [ 15 ]. Viral infections such as HAV, HBV, HCV, and HIV were excluded after standard tests.…”

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

“…Recent studies have indicated that resumption of alcohol abuse following LT leads to significantly reduced survival rates. Patients who resumed heavy drinking have been reported to have 5- and 10-year survival rates of 69.5% and 20.1%, respectively, compared to 90.3% and 81.5%, respectively, in abstinent patients[ 7 , 190 , 199 ].…”

“…Based on a multivariate analysis, only two factors were independently associated with harmful relapse: Lack of prior participation in an alcohol rehabilitation program and single versus married status[ 196 ]. Younger women dependent on alcohol shortly before LT are at greatest risk of relapse[ 199 ].…”