Alcohol Use Relapse Following Liver Transplantation for Alcoholic Liver Disease

Abstract

Background Alcohol use disorders affect 10% of the European population. Alcohol-related liver disease (ALD) is the most common indication for liver transplantation in Slovakia. The aim of this study was to determine the proportion of patients with ALD who received a liver transplant who had alcohol relapsed, and the risk factors for alcohol relapse, as well as to compare clinical outcomes according to relapse. Material/Methods A retrospective study of consecutive patients with ALD, who underwent liver transplantation in a single transplant center between May 2008 and December 2017. We included adult patients who received a liver transplant due to ALD and excluded those who died <1 month after liver transplantation. We recorded demographic and clinical characteristics, graft injury, and overall mortality and compared them between relapsers and abstainers. Results During the study period, we reviewed 196 cases of liver transplantation in 191 patients. We excluded 87 patients for non-ALD etiology and 15 patients by predefined criteria. The final analysis was carried out in 89 patients, mean aged 55 years; 24.7% were female. We diagnosed relapse in 23 patients (26%) with harmful drinking in 52% and occasional drinking in 48% of relapsers. The independent risk factors associated with relapse were: smoking (OR=5.92, P =0.006), loss of social status (OR=7.61, P =0.002), and time after liver transplantation (OR=1.0008, P =0.015). Graft injury was more frequent in relapsers with 2 independent risk factors: occasional drinking (OR=12.7, P =0.0005), and harmful drinking (OR=36.6, P <0.0001); overall survival was unaffected. Conclusions We found relapse to alcohol drinking in 26% of patients who received a liver transplant for ALD. Risk factors associated with alcohol drinking relapse were time, cigarette smoking, and loss of social status. Graft injury was more frequent in relapsers, but mortality was similar between relapsers and non-relapsers.

Significance and clinical impact of routinely tested urinary ethyl glucuronide after liver transplantation – development of a risk score

“…Prior studies have identified various parameters that are heterogeneously correlated with alcohol abuse after liver transplantation, such as tobacco smoking [2,26], social status/support [2,26], time since transplantation [2], age [5], and psychiatric comorbidity [26]. In our study, there was no significant difference for most of these factors between the uEtG negative and the uEtG positive group.…”

“…The impact of alcohol abuse after liver transplantation is best documented in patients transplanted for alcoholic liver disease (ALD). In these patients, alcohol relapse can lead to diminished graft survival as well as contribute to reduced patient survival, especially when higher amounts of alcohol (>30 g/day) are consumed [1][2][3][4][5]. Furthermore, alcohol abuse is associated with reduced patient compliance and the occurrence of nonhepatic cancers, which further endanger graft and patient survival.…”

End stage liver disease etiology & transplantation referral outcomes of major ethnic groups in British Columbia, Canada

“…For example, hepatitis C viremia, pre-direct acting antiviral therapy, was common post-transplant, and greater than 20% of patients with alcohol related liver disease will relapse after transplant. [ 34 ] PSC, which was higher in these populations, is also prone to recurrence. [ 35 ] Overall, this data suggests that graft survival is similar among ethnicities despite differences in rates of rejection episodes and disease recurrence.…”

Main factors influencing long-term outcomes of liver transplantation in 2022

“…Smokers have a 79% higher risk of dying compared to nonsmokers[ 115 ]. A history of smoking is not only a well-known risk factor leading to the major causes of death in the long-term post-LT, such as development of cardiovascular complications and de novo neoplasms, as showed by a recent meta-analysis[ 118 ], but it has also been associated with alcohol relapse in ALD-transplanted patients[ 119 ], recurrent viral-hepatitis[ 120 ], an augmented risk of IBD flare in PSC-transplanted patients[ 121 ], and with an increase in biliary complications[ 122 ]. On the other hand, an increased time from smoking cessation to transplantation seems to be a protective factor against developing biliary complications[ 123 ].…”