Management of alcohol recurrence before and after liver transplantation

Marroni, Cláudio Augusto

doi:10.1016/j.clinre.2015.06.005

Cited by 23 publications

(21 citation statements)

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“…Precise alcohol intake per day is difficult to assess outside LT and is probably even harder to evaluate for LT recipients who are strongly asked to remain abstinent and may therefore feel guilty to declare alcohol intake. Different tools such as the Alcohol Use Disorders Identification Test and carbohydrate‐deficient transferrin could be helpful to estimate as accurate as possible alcohol intake . Moreover, liver biopsies were not performed at the same interval for each patient, or some patients had a small number of biopsies and only in the early years after relapse; the histological evaluation after relapse could therefore have underestimated or delayed the diagnosis of severe graft injury, even if the number of biopsies was not different for patients with or without RAC.…”

Section: Discussionmentioning

confidence: 99%

“…Different tools such as the Alcohol Use Disorders Identification Test and carbohydrate-deficient transferrin could be helpful to estimate as accurate as possible alcohol intake. (29)(30)(31) Moreover, liver biopsies were not performed at the same interval for each patient, or some patients had a small number of biopsies and only in the early years after relapse; the histological evaluation after relapse could therefore have underestimated or delayed the diagnosis of severe graft injury, even if the number of biopsies was not different for patients with or without RAC. Finally, pathologists were not blinded to the alcohol use.…”

Section: Discussionmentioning

confidence: 99%

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Severe alcoholic relapse after liver transplantation: What consequences on the graft? A study based on liver biopsies analysis

et al. 2016

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Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse. The aims of this study were to evaluate the impact of severe alcoholic relapse on the graft (based on histological examination) and to identify predictive factors associated with recurrent alcoholic cirrhosis (RAC). From 1990 to 2010, 369 patients underwent LT for ALD at Edouard Herriot Hospital (Lyon, France) and survived more than 1 year. All patients who presented severe alcoholic relapse and histological follow-up were included. Liver biopsies were performed at 1 and 5 years and at every 5 years after LT, and when clinically indicated. The median follow-up after LT was 11 years (range, 3-18 years). Severe alcoholic relapse was observed in 73 (20%) of the 369 patients, from whom 56 patients with histological evaluation were included. RAC was diagnosed in 18 (32%) of the 56 patients included, which represents 5% of the 369 patients transplanted for ALD. The median delay between LT and RAC was 6 years (range, 3-10 years) and 4.5 years (range, 2-8 years) after severe alcoholic relapse. The median cumulated years of alcohol use before RAC was 3.5 years (range, 2-7 years). The cumulative risk for F4 fibrosis was 15% at 3 years, 32% at 5 years, and 54% at 10 years after severe alcoholic relapse. A young age at LT ( £ 50 years old) and an early onset of heavy drinking (within the first 3 years after LT) were associated with RAC. In conclusion, severe alcoholic relapse usually occurs in the first years after LT and is responsible for accelerated severe graft injury.Liver Transplantation 22 773-784 2016 AASLD. SEE EDITORIAL ON PAGE 720Alcoholic liver disease (ALD) is the second most common indication for liver transplantation (LT) in Western countries and has a steadily increasing rate. (1) Because of organ shortage and ethical issues, a major challenge for transplant teams is to select patients who are most able to maintain sobriety after transplantation in order to prevent alcohol relapse and related complications. Despite the efforts of LT programs to select abstinent patients, severe alcoholic relapse after transplantation is observed in approximately 20% of the patients. (2,3) The most significant risk factors associated with severe alcoholic relapse after LT are a shorter length of sobriety before transplantation, a familial history of alcoholism, and the existence of psychiatric comorbidities. (3,4) During the last decade, a focus has been made on deleterious effects of severe alcoholic relapse after LT and its negative impact on longterm survival, whatever the primary indication. (5) Mortality in heavy drinkers is mostly due to recurrent alcoholic cirrhosis (RAC) and de novo malignancies. (5-7) Nevertheless, the impact of alcohol relapse on an allograft, based on histological analysis, has not been extensively studied. Previous studies have shown that heavy Abbreviations: ALD, alcoholic liver disease; BMI, body mass index; HCV, hepatitis C virus; LT, liver transpla...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe alcoholic relapse after liver transplantation: What consequences on the graft? A study based on liver biopsies analysis

et al. 2016

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“…Moral judgment on what is considered a self-inflicted disease might influence public opinion [23][24][25]. However, ethical principles recommend whole and effective treatment of these patients without discrimination [26][27][28][29][30].…”

Section: Selection Of Candidates For Liver Transplantation Due To Alcmentioning

confidence: 99%

Alcohol use disorder and liver transplant: new perspectives and critical issues

Gitto

Aspite

Golfieri

et al. 2020

Korean J Intern Med

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Alcoholic liver disease is a consolidated indication for liver transplantation, but many unsolved issues can be highlighted. Patients with alcohol use disorder develop peculiar comorbidities that can become contraindications for transplantation. Moreover, a number of social and psychological patterns should be evaluated to select candidates with a low risk of alcohol relapse and adequate post-transplant adherence. In this context, the 6-month rule is too rigid to be widely applied. A short period of abstinence (1 to 3 months) is useful to estimate recovery of liver function and, possibly to avoid transplant. Cardiovascular disorders and extra-hepatic malignancies represent the main clinical issues after transplant. Patients transplanted due to alcoholic disease are a major risk for other liver diseases. Severe corticosteroid-resistant alcoholic acute hepatitis is a debated indication for transplant. However, available data indicate that well-selected patients have excellent post-transplant outcomes. Behavioral therapy, continued psychological support and a multidisciplinary team are essential to achieve and maintain complete alcohol abstinence during the transplant process. Alcoholic liver disease is an excellent indication for a liver transplant but patients with alcohol use disorder deserve a personalized approach and dedicated resources.

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“…Multiple studies focused on predictive factors in the pre‐LT period have aimed at screening patients at high risk of alcohol relapse . Some of the results of these investigations have showed the positive results of the “6‐month abstinence rule”, which suggested that patients who did not abstain from alcohol intake for at least 6 months should not be listed for LT, due to their high relapse rate .…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] Multiple studies focused on predictive factors in the pre-LT period have aimed at screening patients at high risk of alcohol relapse. [11][12][13][14][15][16] Some of the results of these investigations have showed the positive results of the "6-month abstinence rule", which suggested that patients who did not abstain from alcohol intake for at least 6 months should not be listed for LT, due to their high relapse rate. 17 However, this rule has recently been reconsidered in many centers and some authors have demonstrated that the opinion of an addiction specialist may be crucial for the inclusion of these patients on the waiting list regardless of the period of abstinence.…”

mentioning

confidence: 99%