Recurrent Alcoholic Cirrhosis In Severe Alcoholic Relapse After Liver Transplantation: A Frequent and Serious Complication

Abstract

RAC occurs in <6% of ALD transplant patients. One-third of severe alcoholic relapse patients develop RAC <5 years after transplantation with a very poor prognosis.

Alcohol Use after Liver Transplantation is Independent of Liver Disease Etiology

“…disease in the allograft (Watt and Charlton, 2010), or inaccurate report by the recipient on alcohol use. Graft loss from alcohol use is rare except among patients with recurrent cirrhosis in the graft, which can occur in about one-third of patients with harmful alcohol relapse after LT and 3% of the original cohort transplanted for alcoholic cirrhosis (Dumortier et al, 2015). Five-year survival among patients transplanted for liver diseases other than hepatitis C is about 70-80%, similar to 73% in our study (Singal et al, 2013b).…”

“…Five-year survival among patients transplanted for liver diseases other than hepatitis C is about 70-80%, similar to 73% in our study (Singal et al, 2013b). Alcohol use has been shown to impact long-term survival after LT (Singal et al, 2013a;Dumortier et al, 2015). Different results in our analysis are likely due to inclusion of transplants in an earlier era (1990)(1991)(1992)(1993)(1994) and relatively shorter follow-up of about 5 years.…”

Liver Illness and Psychiatric Patients

“…In Europe, 30 to 50% of liver transplantations are related to alcohol, whereas the percentage is much lower (17.2%) in the USA (19). Despite all the precautions taken, unfortunately, 18% of these patients experience severe relapse and one third of them show alcoholic cirrhosis recurrence (20). A multi-disciplinary approach to select and follow patients is crucial to reduce the risk of alcohol recurrence after liver transplantation.…”

Transplantation in alcohol-induced liver diseases-a kind of gene therapy for addictive behaviour?

“…For example, Moos and colleagues describe abstinence rates of between 36 and 45% in a 1-year follow-up, comparing different therapeutic approaches [3]. A recent study by Dumortier and colleagues describes a rate of 18.0% for severe alcohol relapse after liver transplantation for alcoholic cirrhosis during a 9-year follow-up [4]; De Gottardi describes a rate of 11.9% for relapse to harmful alcohol consumption over a period of 15 years [5]. These relatively low relapse rates are especially surprising when taking into account that alcohol-dependent patients suffering from liver cirrhosis leading to organ transplantation represent a subgroup of very severely dependent patients, in many cases not receiving specialized addiction treatment post-transplantation.…”

“…Many of these will be embarking on a life-long addiction which kills nearly 100 000 people in the United Kingdom each year, more than the next six causes of preventable premature death put together [4].…”