Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation

Abstract

End-stage liver disease secondary to alcoholic cirrhosis conThe prediction of abstinence from ethanol may be tinues to be a significant cause of death. 1 Most alcoholics with crucial to the optimal selection of liver transplantation end-stage liver disease do not have significant extrahepatic candidates with alcoholism. Of 84 consecutive end-stage complications of ethanol abuse. 2 Therefore, these patients are alcoholic patients who underwent transplantation not usually excluded because of other terminal medical condi-(1986-1994) at our institution, we analyzed 63 long-surtions, and many times will die shortly without transplantaviving recipients for pretransplantation variables to tion intervention. 2 Furthermore, excellent survival following predict posttransplantation abstinence (follow-up: 49.3 liver transplantation is noted with alcoholic recipients. [3][4][5][6][7][8][9][10][11] Be-{ 21 mo). Thirty-three pretransplantation variables cause these patients usually have liver disease solely because were reviewed from our transplantation data base and of the intake of a toxin (ie, ethanol), abstinence from this supplemented and confirmed with interviews with retoxin usually predicts minimal problems with liver disease cipients. The psycho-social inclusion criteria included following liver transplantation. The appropriate allocation of the following: patient recognition of alcoholism, a domiliver transplantation to specific alcoholic patients is made cile, an occupation, and at least one close personal relamore difficult by the large number of patients with end-stage tionship. The incidence of abstinence from ethanol was alcoholic cirrhosis and the intense demand for donor organs (50/63) 79%. A logistic regression of the 33 variables in for other end-stage liver diseases in which disease recurrence conjunction with our above inclusion criteria accurately may be less likely or more predictable. 12-14 Herein lies the predicted abstinence (90% accuracy, x 2 model, P õ problem that besets transplantation physicians: the appro-.00001) based on the absence of previous history of any priate selection of alcoholics with end-stage liver disease for illicit drug use (Drug Use: yes Å 1/no Å 0), the presence transplantation based on the prediction of long-term abstiof an active, personal life insurance policy (Life Ins: yes nence from alcohol. number of alcoholic sisters (ETOH-SIS), andThe aims of this study are to describe the following: 1) the the length of pretransplantation abstinence (PREresults of liver transplantation for patients with alcoholic TRANS-ABS, mos): Prob. of abstinence Å 1/1 / e 0F , F Å end-stage liver disease (survival, the incidence of abstinence, 00.33 / 0.89 (DRUG USE) 01.02 (LIFE INS) 01.68 (ETOHand pattern of recidivism); and 2) an analysis of pretrans-SIS) /0.24 (PRE-TRANS-ABS). In contrast, receiver-opplantation variables that may predict abstinence from alcohol erating characteristic curve analysis found that 7 and 9 following transplantation. months of pretransplantation abstinence were the be...

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

“…There was no significant difference between age at transplantation and socioeconomic status between recidivists and abstainers. Although significant associations between comorbid drug use, history of drinking and driving, and family history have been described elsewhere, 19 we were unable to support this. However, in agreement with previous studies, there was no significant link between smoking, level of social support, and marital status at transplantation.…”

“…However, it has been shown that survival of abstinent patients is significantly greater than in those consuming alcohol. 19 The period of follow-up was relatively short, and patients reported as abstinent may simply have not been given enough time to relapse, thus underestimating recidivism rates. This is suggested by findings that the frequency of relapse increases as the duration of follow-up is extended.…”

“…9,13,19,25,26 Based on some of these studies, criteria for listing patients with ALD for transplantation in many centers often includes a period of abstinence, usually 6 months. Although this unit also uses such criteria when selecting patients with ALD, 3 of the 46 patients with ALD for whom we obtained relevant information had not been abstinent during the 6 months before transplantation because their hepatic reserve did not allow for it.…”

“…Other factors investigated include recreational drug use, acknowledgment of being an alcoholic, psychiatric history, marital status, employment history, education, family history of alcoholism, social support, and hobbies. 14,16,19 However, only one variable, pretransplantation sobriety, was consistently associated with recidivism. 8,9,13 Some centers operate a period-of-abstinence policy, whereas others believe the evidence is inconclusive 1,3,10,16 and such a policy is unfair because patients with limited life expectancy will be excluded.…”

“…9,[11][12][13][14][15][16] These patients may return to a pattern of alcohol consumption that poten-tially damages the transplanted liver, as well as affects compliance with the immunosuppressive regimen and follow-up appointments, which may put the graft at risk. 2,17 Reported rates of recidivism vary between 0% and 95% 1,3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21] ; in part, this discrepancy can be attributed to the definition of recidivism used. There is a relatively low incidence of recidivism in short-term periods of follow-up [9][10][11] ; however, more recent studies suggested that recidivism rates increase with longer followup.…”