Liver Transplantation for Alcoholic Liver Disease: Survival of Patients Transplanted with Alcoholic Hepatitis Plus Cirrhosis as Compared with Those with Cirrhosis Alone

Abstract

From January 1986 through December 1991, a total of 221 patients with alcoholic liver disease received liver transplantation. In 147 of these cases, complete pretransplant histopathologic, demographic, and laboratory data (minimum of CBC, AST, ALT, total bilirubin, albumin, and prothrombin time) were available for review. Forty-five (30%) of the 147 recipients had alcoholic hepatitis plus cirrhosis (AH), whereas 70% had cirrhosis (CIRR) alone. Age and sex were similar in the subgroups, but the patients with CIRR had a greater AST/ALT ratio, longer protime, and lower platelet count (all p < 0.01). Coexistent hepatitis B (4.7%) or hepatitis C (4.1%) was similar in both groups. Current survival is 80% for patients with AH and 84% for those with CIRR (NS). Overall, survivors were younger (43.4 +/- 1.7 years) than nonsurvivors (53.6 +/- 3.2) (p < 0.01), an age influence that was significant in the CIRR group (p < 0.01) but not in the AH group. Inexplicably, the AST/ALT ratio was greater in AH survivors (1.5 +/- 0.2) than it was in nonsurvivors (0.4 +/- 0.1) (p < 0.01). In patients with CIRR, the platelet count was greater in survivors (252 +/- 29 vs. 86 +/- 11 x 10(9) cells/liter). The data support the clinical impression that patients with chronic decompensated cirrhosis referred for liver transplantation had more severe complications of their liver disease than did those with AH. Survival in both subgroups was similar, but overall the survivors are nearly a decade younger than the nonsurvivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation

“…Yates et al 49 and others [18][19][20]25,35,50 have questioned using the duration of abstinence (6 months or other intervals) to predict recidivism. Also, in this study, a period of abstinence of less than 6 months before evaluation did not independently predict the presence or absence of alcohol consumption after OLT.…”

“…Patients with acute alcoholic hepatitis would be evaluated 3 to 6 months after the resolution of the alcoholic hepatitis. 25 Patients who underwent OLT and were documented to be consuming alcohol through monthly random alcohol testing were immediately placed in intensive rehabilitation programs. This treatment process included active intervention from psychiatric and social services in their local community, as well as from within our transplant center.…”

Employment and alcohol use after liver transplantation for alcoholic and nonalcoholic liver disease: A systematic review

“…The methods used to assess alcohol use varied widely: 84% used patient interviews, 16% used questionnaires, 47% used blood and urine alcohol tests, and 21% used abnormal liver function test results as a surrogate marker of alcohol use (many assessed alcohol consumption in multiple ways). Eleven of the 37 studies reported their definition of alcohol relapse: 10 studies used "any alcohol use posttransplantation," 15,17,[19][20][21]27,33,[41][42][43]59,60,65,66,86 and 1 study used "clinically significant alcohol consumption," 79 which was not defined further in the published text.…”

“…The reasons for excluding studies are listed in Table 1 65,66 ; and Pittsburgh. 19,[87][88][89] This reduced to 68 the total number of included studies ( Table 2). Among the included studies, potentially overlapping data are presented from the following institutions: Birmingham, UK; King's College, UK; and multisite studies in France; Vienna, Austria; Virchow Clinic, Berlin, Germany; University of Colorado; University of Pittsburgh; Duke; and the University of Michigan.…”

Immunological response in alcoholic liver disease

“…One other factor to support the immune system is seen in alcoholic patients who have received a liver transplant. If these individuals start consuming ethanol, hepatic fibrosis or cirrhosis occurs much more quickly than the years it took to develop prior to transplant [119] . This quick memory response to the liver suggests that the adaptive immune system is involved.…”