Psychiatric outcome in alcoholic liver transplant patients

Howard, Louise M.; Fahy, Tom; Wong, Philip; Sherman, David; Gane, Edward; Williams, Roger

doi:10.1093/oxfordjournals.qjmed.a068890

Cited by 77 publications

(63 citation statements)

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“…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.…”

mentioning

confidence: 99%

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

Mackie¹

2001

Liver Transplantation

157

102

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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.)

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confidence: 99%

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

Mackie¹

2001

Liver Transplantation

157

102

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“…Short-term follow-up studies have documented a risk for recidivism after OLT in 7% to 95% of patients with a diagnosis of alcohol dependence or abuse. 5,6,[8][9][10][11][12][13][14][15][16][19][20][21][22] Alcohol-induced liver disease with resulting graft failure has been documented in liver transplant recipients. 2,3 An increasing number of patients die awaiting OLT because of a continual increase in the number of patients on the waiting list and minimal increases in donor supply in recent years (United Network for Organ Sharing, 1995).…”

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confidence: 99%

Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation

Gish¹

2001

Liver Transplantation

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The selection of patients with cirrhosis and the diagnosis of alcohol dependence or abuse who have a long-term high probability of abstinence after orthotopic liver transplantation (OLT) may enhance patient survival and outcomes. The aim of this study is to identify factors that would predict which patients would consume alcohol after OLT. Sixty-one patients with a history of alcohol dependence or abuse underwent OLT from June 1989 to June 1994 and were followed up monthly for a median of 6.9 years after OLT (range, 2.5 to 9.3 years). Survival analysis techniques (Cox proportional hazard model) were used to identify patients at high risk for recidivism. Recidivism occurred in 12 of 61 patients (20%) after OLT during follow-up. Noncompliance, with a relative hazard of 20.9 (95% confidence interval [CI], 5.6 to 78.3; P < .001), and personality disorder, with a relative hazard of 6.0 (95% CI, 1.9 to 18.7; P ‫؍‬ .002), independently predicted recidivism among patients who underwent OLT. These data indicate that specific behaviors and psychiatric diagnoses can be used to select patients at high risk for drinking alcohol before and after OLT. (Liver Transpl 2001;7:581-587.)

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“…18 Prevalence of alcohol relapse after liver transplantation varies widely. [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.…”

Section: Predictors Of Relapsementioning

confidence: 99%

Liver Transplantation for Alcohol-Related Liver Disease

Choudhary

Kumar

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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Alcoholic liver disease (ALD) is a common indication for liver transplantation. It is a much debated indication for deceased donor liver transplantation due to organ shortage and potential of alcohol relapse after liver transplantation. A six-month abstinence before liver transplantation is required at most centers to decrease chances of alcohol relapse after liver transplantation. However, this rule is not relevant for patients with severe alcoholic hepatitis or severely decompensated patients who are unlikely to survive till 6 months. Long-term care of these patients after liver transplantation includes assessment of relapse, smoking, and surveillance of de novo malignancies. Current review discusses role of abstinence, factors affecting alcohol relapse, liver transplantation for alcoholic hepatitis, role of living donor liver transplantation, and long-term care of ALD patients who undergo liver transplantation. ( J CLIN EXP HEPATOL 2016;6:47-53) A lcoholic liver disease (ALD) is common indication for liver transplantation worldwide, 1,2 and is a common cause of decompensated cirrhosis and acute-on-chronic liver failure in India as well. 3,4 ALD has good outcome after liver transplantation that is comparable or better than other etiologies of liver transplantation. Recent European liver transplant registry data showed 73% 5-year and a 59% 10-year survival rate for ALD. 2 However, survival is lower in recipients who relapse to harmful pattern of drinking as noted in a systemic review of 13 studies by Rustad et al. 5 Liver transplantation for ALD leads to improvement in quality of life and employment rates. 6,7 During selection of these patients for liver transplantation, it is important to identify other alcohol-related problems like cardiomyopathy, chronic pancreatitis, skeletal muscle wasting, and neurotoxicities that may preclude or impair outcome of liver transplantation. 8 Patients who have lack of social support, are active smokers, and have psychiatric disorders or alcohol dependence should be listed only with reservations. 9 Smoking worsens the outcome of alcohol-related liver disease 10 and active smoking at the time of liver transplantation has been shown to be associated with post-transplant recidivism also. 11 PREDICTORS OF RELAPSEWhile liver transplantation improves functions of liver and cures complications of portal hypertension, it does not affect alcoholism and recipients may relapse again, sometimes to harmful levels of drinking, and pretransplant sobriety does not confirm sobriety after liver transplant. [12][13][14] Relapse may be in the form of occasional slips or harmful drinking pattern for a prolonged period; the later affects graft and patient survival. 5,11 Initially, 6-month abstinence was considered as a requirement before allocating organ to patients with ALD; however, it was based on poor quality small data. 15 The 6-month rule serves 2 purposes; it provides patient time to demonstrate a certain period of abstinence and patient may recover on medical management, and thus preempt...

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Psychiatric outcome in alcoholic liver transplant patients

Cited by 77 publications

References 0 publications

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

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

Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation

Liver Transplantation for Alcohol-Related Liver Disease

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