Liver Transplantation for Alcoholic Liver Disease: A Systematic Review of Psychosocial Selection Criteria

Mccallum, Seònaid; Masterton, George

doi:10.1093/alcalc/agl033

Cited by 117 publications

(80 citation statements)

References 25 publications

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“…The authors showed that although pre-OLT abstinence duration was a predictor on the frequency as well as time to relapse to alcohol abuse after OLT, even in patients who were sober for 36 mo, only 40% remained sober after OLT [13] . The lack of correlation of post-OLT recidivism with 6 mo abstinence prior to OLT was also shown by McCallum et al [14] in their systematic review of 11 studies. Only 2 of the studies showed an association while 9 studies did not show an association between 6 mo pre-OLT abstinence and post-OLT recidivism [14] .…”

Section: Ethical Concerns and Issuesmentioning

confidence: 59%

“…The lack of correlation of post-OLT recidivism with 6 mo abstinence prior to OLT was also shown by McCallum et al [14] in their systematic review of 11 studies. Only 2 of the studies showed an association while 9 studies did not show an association between 6 mo pre-OLT abstinence and post-OLT recidivism [14] . Does this mean that recidivism after OLT is not important?…”

Section: Ethical Concerns and Issuesmentioning

confidence: 59%

“…One problem is that these rates include any amount of drinking, including social drinking. For the purposes of graft and OLT outcome, the consideration should be a relapse to harmful drinking sufficient to cause liver damage [14] . Heavy drinking after LT in alcoholic liver disease as a whole is reported in less than 10% of patients [15] .…”

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

“…Heavy drinking after LT in alcoholic liver disease as a whole is reported in less than 10% of patients [15] . Moreover, the definition of harmful drinking varies from study to study [14] . Further, documenting alcohol use by history taking is not always accurate since patients may not always tell the truth [16] .…”

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

“…Therefore, the issue of recidivism is essential to accurately identify patients prior to OLT who are likely to relapse to harmful drinking after the OLT. In a systematic review on 22 studies, McCallum et al [14] identified factors consistently associated with recidivism-younger age (2 studies), associated poly substance abuse (3 studies), lack of social support (7 studies), family history of alcohol abuse in a first degree relative (3 studies), poor response to previous rehabilitation programs (2 studies) and non-compliance (2 studies). Concomitant mental and psychiatric disorders were associated in 2 studies while 2 studies did not find this association.…”

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

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Liver transplantation in acute alcoholic hepatitis: Current status and future development

Singal

Duchini

2011

WJH

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Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse. Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline. Clearly, a need for an additional more effective treatment option is unmet currently. Liver transplantation (LT), a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence. However, this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation. Shortage of donors, ethical issues, and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH. These issues are debated at length in this manuscript. Further, retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes. Recently, French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to corticosteroid and/or pentoxifylline therapy. Future studies are needed to identify patients with severe AH who are going to benefit most with LT. In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids, the time is ripe to re-evaluate our policy of LT in patients with AH.

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Section: Ethical Concerns and Issuesmentioning

confidence: 59%

Section: Ethical Concerns and Issuesmentioning

confidence: 59%

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

Section: Recidivism After Orthotopic Liver Transplantationmentioning

confidence: 99%

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Liver transplantation in acute alcoholic hepatitis: Current status and future development

Singal

Duchini

2011

WJH

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A Simple Score for Predicting Alcohol Relapse After Liver Transplantation

Gottardi¹,

Spahr²,

Gelez³

et al. 2007

Arch Intern Med

198

205

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Background: Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT. Methods: A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean ± SD age was 51.3±7.5 years. Follow-up time was 61.2 ± 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied. Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years (P=.04), year of LT 1995 or earlier (PϽ.05), duration of abstinence less than 6 months (P= .02), presence of psychiatric comorbidities (PϽ.001), presence of a life partner (PϽ.05), and a high score on the High-Risk Alcoholism Relapse (HRAR) scale (PϽ.001). Mul-tivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.2-9.3) (P =.02); presence of psychiatric comorbidities (OR, 7.8; 95% CI, 3.1-20.0) (PϽ.001); and HRAR score higher than 3 (OR, 10.7; 95% CI, 3.8-30.0) (P=.001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively. Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.

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Evaluation of Early vs Standard Liver Transplant for Alcohol-Associated Liver Disease

et al. 2021

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IMPORTANCETraditionally, liver transplant (LT) for alcohol-associated liver disease (ALD) requires 6 months of abstinence. Although early LT before 6 months of abstinence has been associated with decreased mortality for decompensated ALD, this practice remains controversial and concentrated at a few centers. OBJECTIVE To define patient, allograft, and relapse-free survival in early LT for ALD, and to investigate the association between these survival outcomes and early vs standard LT. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed all patients with ALD who underwent their first LT at a single academic referral center between October 1, 2012, and November 13, 2020. Patients with known pretransplant hepatocellular carcinoma, hepatitis B or C, or an alternative cause of liver failure were excluded. Follow-up period was defined as the time from LT to the most recent encounter with a transplant center or death.EXPOSURES The exposure of interest was early LT, which was defined as less than 180 days of pre-LT abstinence. Standard LT was defined as 180 days or more of pre-LT abstinence. Patients were separated into early LT and standard LT by time from abstinence to LT. MAIN OUTCOMES AND MEASURESThe outcomes were patient, allograft, relapse-free, and hazardous relapse-free survival for patients who underwent early LT or standard LT. These groups were compared by log-rank testing of Kaplan-Meier estimates. Hazardous relapse was defined as binge, at-risk, or frequent drinking. Abstinence was reassessed at the most recent follow-up visit for all patients. RESULTSOf the 163 patients with ALD included in this study, 88 (54%) underwent early LT and 75 (46%) underwent standard LT. This cohort had a mean (SD) age at transplant of 52 (10) years and was predominantly composed of 108 male patients (66%). Recipients of early LT vs standard LT were younger (median [interquartile range (IQR)] age, 49.7 [39.0-54.2] years vs 54.6 [48.7-60.0] years; P < .001) and had a higher median (IQR) Model for End-stage Liver Disease score at listing (35.

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Liver Transplantation for Alcoholic Liver Disease: A Systematic Review of Psychosocial Selection Criteria

Cited by 117 publications

References 25 publications

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Liver transplantation in acute alcoholic hepatitis: Current status and future development

A Simple Score for Predicting Alcohol Relapse After Liver Transplantation

Evaluation of Early vs Standard Liver Transplant for Alcohol-Associated Liver Disease

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