Risk of alcohol use relapse after liver transplantation for alcoholic liver disease

Abstract

AIMTo investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).METHODSThe clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial criteria.RESULTSOf the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period (P < 0.01), duration of heavy drinking (P < 0.05), adherence to medical treatment (P < 0.01), and declaration of abstinence (P < 0.05).CONCLUSIONPatients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.

Systematic review with meta-analysis on transplantation for alcohol-related liver disease: Very low evidence of improved outcomes

“…Gaps in reporting: Supplementary Table 1 shows individual trial details, highlighting gaps in reporting regarding assessment and treatment of underlying AUD, diagnosis of ALD, requirement of a period of abstinence prior to transplant, details of relapse (definition and assessment), and accounting for or restricting to the presence of AH and or SAH. Two of the studies did not report how ALD was diagnosed[22,23], and the remaining 8 studies used a range of diagnostic criteria - some studies included mixed liver etiology (alcohol and other causes of liver disease)[24]; others defined ALD by alcohol consumption ranging from 50 g/d for both men and women[25], greater than 3 units per day for men or 2 units per day for women[26], or greater than 80 g/d for men or 60 g/d for women[21]; and the most recent studies did not specifically quantify the amount[18,19,27]. The majority of studies did not require pathological diagnosis, specify a required period of abstinence, or differentiate where patients were classified on the spectrum of ALD.…”

“…The randomized control trial[23], the only abstract included in the analysis, had an unclear risk of bias across the different categories. Four of the later studies appeared at substantial risk of bias - the two case-control studies had a higher risk of selection and outcome bias[18,19] while the other two were at risk of comparability bias[21,27]. Two earlier studies were additionally at risk of outcome bias[24,25].…”

“…Adverse events: Four studies specified the occurrence of graft dysfunction and re-transplantation[18,19,25,27]. Of these four, the study with the longest follow-up observed graft dysfunction in two of their 31 transplant patients with relapse (6%), of which one (50%) underwent re-transplant, the other which died (Supplementary Table 3)[25].…”

Successful Post-Transplant Psychiatric Interventions During Long-Term Follow-Up of Patients Receiving Liver Transplants for Alcoholic Liver Disease

“…He has been followed up regularly by transplant surgeons and recipient coordinators, as well as by frequent psychiatric supervision, and has successfully continued to abstain from alcohol for 6 years. We also discussed this case in a previous study [ 8 ].…”

“…Based on the results of a Japanese survey of LT for ALD patients [ 4 ], the criterion of alcohol abstinence for 6 months used [ 5 , 6 ] for living- and deceased-donor LT registration was changed to abstinence for 18 months for deceased-donor LT [ 7 ]. In addition to these abstinence criteria, Nagoya University Hospital carried out psychosocial assessments before transplantation to prevent additional alcohol consumption [ 8 ], as shown in Table 1 . However, despite these strict criteria, additional alcohol consumption was observed a few years after LT [ 9 ], suggesting that long-term follow-up is required in LT recipients.…”