Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism

Abstract

The aim of this study performed at the Liver Unit at the Queen Elizabeth Hospital, Birmingham, UK, is to assess posttransplantation alcohol consumption and identify risk factors associated with recidivism. This retrospective case-control study used a self-report questionnaire to assess pretransplantation and posttransplantation drinking, and a retrospective cohort study used patient notes to analyze risk factors for recidivism. Of 64 patients who underwent transplantation for alcoholic liver disease (ALD) between May 1996 and November 1999, a total of 49 surviving patients (40 men, 9 women) were available for study. The comparison group consisted of 49 patients matched for age, sex, and date of transplantation who underwent transplantation for non-alcohol-induced chronic liver disease. Two-year patient survival rates were 82% in both study groups. The questionnaire response rate was 69.3% and 75.5% in patients with and without ALD, respectively. Data on recidivism (defined as any alcohol consumption after transplantation) were available in 46 of the 49 patients with ALD. Of these, 45.6% were drinking; 21.7% reported only occasionally drinking; 17.3%, moderate drinking; and 6.5%, heavy drinking. Information on alcohol consumption was available from 41 of the 49 controls. Of these, 52.5% consumed alcohol; 22.0% reported drinking only on special occasions; 24.4%, moderate drinking; and 4.9%, a return to heavy drinking. However, these differences were not statistically significant, and log-rank analysis found no significant difference in time to resumption of drinking. In the ALD cohort, no significant risk factors were identified to predict recidivism. No pretransplantation risk factors (including period of abstinence before transplantation) correlated with recidivism. Survival after transplantation for ALD is similar to that in other forms of chronic liver disease. Recidivism rates for patients with ALD are high, but patients with ALD do not drink more than their control counterparts posttransplantation. In most instances, alcohol consumption posttransplantation is minimal to moderate (<20 units/wk) and seems to be controlled. (Liver Transpl 2001;7:418-427.)

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

“…In addition, there is a preponderance of evidence supporting that a pretransplant abstinence period of six months has become a mandatory selection criterion [8,[11][12][13][19][20][21] , as its benefit was reported by Bird et al [6] in 1990. However, there are also reports indicating that an abstinence period of more than six months is not a significant predictive factor for alcoholic recidivism [22][23][24] , along with those demonstrating that LT candidates with ALD barely survive for six months even with no alcohol intake [15,23] . A solid validation for requiring pre-transplant abstinence, as well as optimal duration of abstinence, if necessary, has yet to be established.…”

Liver Transplantation for Alcohol-Related Liver Disease

“…[19][20][21] This wide range of relapse after liver transplantation reflects several methodological differences among studies, variable follow-up, and difference in definition of relapse (any alcohol intake versus harmful drinking). 21 Mackie et al 22 compared alcohol intake in alcoholics with other etiologies of liver transplantation and found similar rates. Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%.…”

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

“…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] . Moreover, the definition of harmful drinking varies from study to study [14] .…”