Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

Bird, George; O’Grady, John; Harvey, Felicity; Calne, R. Y.; Williams, Roger

doi:10.1136/bmj.301.6742.15

Cited by 182 publications

(82 citation statements)

References 5 publications

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“…However, a recent study suggests that the quality of life may diminish slightly after 3 yr in these patients (143). A high rate of abstinence from alcohol has been observed in these patients after transplantation, with recidivism rates varying between 11% and 33% (137)(138)(139)(140)(141)(145)(146)(147)(148)(149). However, recent data suggest that recidivism rates may increase with longer follow-up (146), increasing from 15% at 1 yr to 31% at 3 yr posttransplant.…”

Section: Liver Transplantationmentioning

confidence: 91%

“…However, recent data suggest that recidivism rates may increase with longer follow-up (146), increasing from 15% at 1 yr to 31% at 3 yr posttransplant. Some studies have found that the rate of recidivism may be related to the duration of abstinence before liver transplantation (137,138,141,147), but this remains controversial (142,150). It should be emphasized that it is difficult to accurately diagnose alcohol consumption and that patients who have been transplanted for nonalcoholic liver disease have shown rates of alcohol use ranging from 24% to 46% (145,147,148).…”

Section: Liver Transplantationmentioning

confidence: 99%

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Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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Section: Liver Transplantationmentioning

confidence: 91%

Section: Liver Transplantationmentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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“…Muitos estudos a respeito da recidiva do consumo de álcool após o TH têm sido publicados na última década (2,6,7,8,9,10,11,13) . A maioria deles são estudos retrospectivos, com períodos relativamente curtos de acompanhamento (geralmente inferior a 5 anos) e número pequeno de pacientes.…”

Section: Discussionunclassified

“…Em 1988, STARZL et al (15) , avaliando 41 pacientes com cirrose alcoólica avançada submetidos a TH na Universidade de Pittsburgh, sob esquema de imunossupressão com ciclosporina, relataram sobrevida em 1 ano de 73,2% e em 3 anos de 68%. Índices satisfatórios de sobrevida em 1 ano pós-TH em portadores de DHA, variando de 66% a 100%, também foram documentados em outros centros americanos e europeus (1,2,5,7,8,9,10,13,14,16) .…”

Section: Introductionunclassified

“…A freqüência com que a recidiva de consumo de bebidas alcoólicas é detectada no acompanhamento pós-transplante é variável, dependendo em parte dos métodos empregados na avaliação e seleção dos candidatos na fase pré-transplante, bem como dos métodos empregados para tal rastreamento dessa complicação no pós-transplante. Publicações relatando a experiência de diferentes centros transplantadores apontam para índices de recidiva em torno de 12% a 50% (2,6,7,8,9,10,11,13) . A necessidade de intervalo de abstinência pré-TH tem sofrido reavaliações, mas a maioria dos centros de transplante adota mínimo de abstinência de pelo menos 6 meses antes do TH.…”

Section: Introductionunclassified

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Resultados do transplante de fígado na doença hepática alcoólica

Parolin

Coelho

Igreja

et al. 2002

Arq. Gastroenterol.

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RACIONAL: O transplante de fígado é aceito como modalidade terapêutica efetiva nas doenças hepáticas avançadas, incluindo a cirrose alcoólica. OBJETIVO: Avaliar os resultados do transplante hepático em pacientes com cirrose alcoólica no Programa de Transplante Hepático do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. PACIENTES E MÉTODOS: Análise retrospectiva dos pacientes com cirrose alcoólica submetidos a transplante hepático no Serviço de Transplante Hepático do Hospital de Clínicas da Universidade Federal do Paraná entre setembro de 1991 e janeiro de 2001. Todos os candidatos apresentavam período de abstinência de álcool > 6 meses antes do transplante. A identificação do consumo de álcool no período pós-transplante hepático baseou-se em: (1) informações fornecidas pelo paciente e/ou familiares, e/ou (2) anormalidades bioquímicas sugestivas de consumo abusivo de álcool associadas a anormalidades histológicas compatíveis com lesão pelo etanol. RESULTADOS: Vinte adultos com cirrose alcoólica (19 homens e 1 mulher) com mediana de idade de 50 anos (29-61 anos) foram submetidos a transplante hepático, correspondendo a 13,8% das indicações de transplante hepático em adultos. Em 30% dos pacientes (6/20) houve associação com hepatite viral crônica, e em 1 caso (5%) presença de hepatocarcinoma. A maioria dos pacientes apresentava disfunção hepática grave no pré-transplante (75% Child C). A mediana do tempo de abstinência pré-transplante foi de 24 meses (9 a 120 meses). A mediana do tempo de seguimento pós-transplante foi de 14 meses (1 a 66 meses). A sobrevida do paciente em 1 e 3 anos após o transplante hepático foi de 75% e 50%, respectivamente. As principais complicações observadas foram: rejeição aguda (n = 8; 40%), rejeição crônica (n = 1; 5%), trombose da artéria hepática (n = 3; 15%), complicações biliares (n = 3; 15%) infecção por citomegalovírus (n = 4; 20%), infecções bacterianas e fúngicas (n = 9; 45%). A incidência detectada de recidiva do consumo de álcool foi de 15% (3/20). Em um dos casos de recidiva o uso inadequado dos imunossupressores resultou em rejeição crônica com perda do enxerto. CONCLUSÕES: Transplante hepático na cirrose alcoólica associou-se a níveis satisfatórios de sobrevida a curto e médio prazo. No presente estudo a recidiva do consumo de álcool foi pequena, o que pode ser devido à falta de rastreamento adequado.

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Resource Utilization and Outcome of Liver Transplantation for Alcoholic Cirrhosis

et al. 1992

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Liver transplantation for alcoholic cirrhosis remains controversial at some transplantation centers. We compared resource utilization and outcome in alcoholic and nonalcoholic cirrhotic patients undergoing liver transplantation. Data were collected from 56 patients who underwent transplantation for alcohol-related cirrhosis from August 1985 to February 1991 and compared with data from a control group matched for age, sex, Child-Pugh class, and date of transplantation. No significant differences were noted in the resource utilization variables examined or in outcome (as assessed by indicators of early graft function, frequency of sepsis, incidence of rejection, renal function, and retransplantation rate). One-year survival was not significantly different (75% for the alcoholic cirrhotic group vs 76% for the nonalcoholic cirrhotic group). We conclude that liver transplantation for end-stage alcohol-related cirrhosis provides excellent results and that resource utilization appears to be equivalent to that for patients undergoing transplantation for non-alcohol-related cirrhosis.

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Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

Cited by 182 publications

References 5 publications

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Resultados do transplante de fígado na doença hepática alcoólica

Resource Utilization and Outcome of Liver Transplantation for Alcoholic Cirrhosis

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