Alcoholic liver disease and transplantation

Jain, Ashokkumar; Fung, John J.

doi:10.1016/s0041-1345(02)03997-0

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…Therefore, it seems preferable to concentrate the monitoring on those likely to have serious complications associated with serious chronic consumption. A complex scale allowing a rational approach for patient selection [23] was tested, but unfortunately, it did not appear very predictive of relapse [5]. We need simple tests that are easy to use during the pretransplant period and that are standardized to isolate a high‐risk subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…Under these conditions, the main goal is not actually to improve patient selection procedures, but rather to detect the severe relapsers who are individuals with poorer survival, to targeting specific interventions after LT [2]. It is also necessary to improve the monitoring strategy used preoperatively to assess alcoholic disease [23]. Indeed, alcoholic transplant recipients are not a homogenous population but could be alcohol abusers, alcohol‐dependent patients, or patients suffering from associated psychiatric disorders [24,25].…”

Section: Introductionmentioning

confidence: 99%

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Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease?

Perney¹,

Bismuth²,

Sigaud³

et al. 2005

Transplant Int

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Summary Predictive factors for alcoholic relapse after liver transplantation (LT) performed for alcoholic liver disease (ALD) have been assessed in numerous studies, often with contradictory results. The aim of the study was to assess pretransplantation alcohol consumption characteristics on alcoholic relapse after LT. Patients transplanted for ALD for at least 6 months were included. An anonymous questionnaire assessed socio‐demographic characteristics, medical history, and alcohol consumption before and after LT. Relapse was defined as any alcohol use after LT. Severe relapse was defined by heavy drinking: more than 21 units/week for males and 14 units/week for females. A total of 61 patients were studied. The mean follow up after LT was 49 ± 34 months. Alcoholic relapse occurred in 32 of 61 patients (52%) and severe relapse in eight of 61 patients (13%). Risk factors for severe relapse were: length of abstinence before LT (P = 0.0001), more than one alcohol withdrawal before LT (P = 0.001), alcohol dependence (P = 0.05), alcohol abuse in first relatives (P = 0.05), and younger age (P = 0.05). Information on previous alcohol consumption (dependence, number of withdrawals, family history) helps to predict severe relapse after LT in patients with ALD, allowing early awareness and specific postoperative care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease?

Perney¹,

Bismuth²,

Sigaud³

et al. 2005

Transplant Int

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“…If these patients remain abstinent, their prognosis is superior to that of patients with liver cirrhosis of other etiologies. However, continued alcohol consumption is considered an absolute contraindication for LT. [1][2][3][4] Therefore, the high percentages of relapse cases before LT (19%-50%) 5,6 and after LT (11%-80%) [7][8][9][10][11][12][13][14][15][16][17][18][19][20] pose a serious problem. [21][22][23][24][25] To ensure abstinence by the patient, a strict and systematic investigation is required.…”

Section: See Editorial On Page 1267mentioning

confidence: 99%

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

Hempel

Greif-Higer²,

Kaufmann³

et al. 2012

Liver Transpl

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Alcoholic liver cirrhosis (ALC) is a commonly accepted indication for liver transplantation (LT). Any alcohol consumption is considered a contraindication for LT. However, the assessment of abstinence in everyday practice mostly relies on patient self-reporting, which must be considered highly unreliable. After consumption, ethanol is eliminated by alcohol dehydrogenase, with methanol accumulating in the blood. Methanol, which is known to be a sensitive and specific indicator for recent alcohol consumption, has not been used for verifying alcohol consumption in LT assessments yet. Therefore, the purpose of this study was to test the feasibility of using methanol testing to identify recent alcohol consumption in LT candidates during routine and short-notice appointments. We compared methanol and ethanol measurements with self-reported alcohol consumption for 41 patients with ALC during the evaluation process before they were accepted onto the waiting list. In 32 of the 92 blood samples drawn from these 41 patients during the study, a relapse was detected by the methanol test. Both the ethanol test results and the self-reported data were positive in only 3 cases. Thus, the methanol test identified 29 additional cases of alcohol consumption. Furthermore, the methanol test discovered recent alcohol consumption in 5 of 10 transplant patients when both self-reported data and ethanol test results were negative. As a part of blood alcohol analysis, the methanol test is more sensitive than self-reporting and ethanol testing for the detection of recent alcohol consumption. Also, short-notice appointments for blood alcohol analysis reveal more cases of alcohol relapse than routine, long-term appointments. The measurement of methanol as a sensitive screening test for recent alcohol consumption should be implemented both in law and in daily, routine practice.

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“…However, it appears that survival beyond 5 to 7 years is worse in patients with ALD due to significantly increased rates of cerebrovascular accidents, myocardial infarction, respiratory failure, infection, and de novo malignancies, believed to be the consequence of prolonged exposure to tobacco and alcohol in these patients. The rate of de novo oropharyngeal cancer and lung cancer was 25 and 4 times higher, respectively, in patients with ALD compared with patients with non‐ALD and the general population using surveillance epidemiological end result data matched for age, sex, and length of follow‐up 16, 17. Implementation of posttransplant screening programs to detect early de novo malignancies may further improve long‐term outcomes in these patients.…”

Section: Questions Regarding Transplantation For Aldmentioning

confidence: 99%

Liver transplantation for alcoholic liver disease: Current concepts and length of sobriety

2004

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Alcoholic liver disease and transplantation

Cited by 7 publications

References 23 publications

Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease?

Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease?

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

Liver transplantation for alcoholic liver disease: Current concepts and length of sobriety

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