Resolution of alcoholic neuropathy following liver transplantation

Abstract

Between 10 and 20% of adult liver transplants are performed for end-stage alcoholic liver disease. Severe extrahepatic end-organ damage from alcoholism (cardiomyopathy, pancreatitis, central nervous system injury, and neuropathy) is widely regarded as an absolute contraindication to liver transplantation, despite a lack of data on the effect of transplantation on these complications. We describe such a patient who presented with decompensated alcoholic liver disease and moderately severe peripheral neuropathy. Both his liver failure and neuropathy progressed despite 9 months abstinence and intensive nutritional support. By 12 months post-transplant, however, this patient had regained almost normal muscle strength, with associated recovery in sensory and motor conduction velocities. Direct alcohol toxicity, nutritional and vitamin deficiencies, and liver failure were all likely etiologic factors in this patient's neuropathy. In conclusion, this case suggests that peripheral neuropathy in a patient with alcoholic cirrhosis may resolve following liver transplantation and should not constitute a contraindication to transplantation, even when it is disabling.

Neuropraxia: An Underappreciated Morbidity of Liver Transplantation

“…Because alcohol-induced toxic neuropathy is relatively common in patients with alcoholic cirrhosis, 14,15 we speculated that these patients may demonstrate a higher incidence of postoperative neuropraxia. However, this was not the case, and indeed neuropraxia was not associated with any specific etiology for liver disease.…”

The Neurology of Solid Organ Transplantation

“…Correction of metabolic disturbances and functioning allograft may result in an improvement of diabetic and alcoholic neuropathy in pancreas and liver allograft recipients [84,85]. Worsening of weakness and diabetic neuropathy after kidney and pancreas transplantation in some patients has been attributed to superimposed myopathy (probably critical illness myopathy) [86].…”

Neuropathies in malnutrition and alcoholism

“…Recovery may require many months, and can be almost complete, but liver transplantation may be required in decompensated alcoholic cirrhosis, since the aforementioned remedies alone are insufficient [17].…”