Selection for and outcome of liver transplantation in alcoholic liver disease

Lucey, Michael R.; Merion, Robert M.; Henley, Keith S.; Campbell, Darrell A.; Turcotte, Jeremiah G.; Nostrant, Timothy T.; Blow, Frederic C.; Beresford, Thomas P.

doi:10.1016/0016-5085(92)91737-o

Cited by 160 publications

(100 citation statements)

References 13 publications

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“…2 However, there is increasing evidence that patients selected for transplantation for ALD have similar, if not better, survival than those who undergo transplantation for other chronic forms of endstage liver disease. 1,3,[8][9][10][11][12][13][14] However, the risk for recidivism is the main concern. 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.…”

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confidence: 99%

“…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.…”

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confidence: 99%

“…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. 17,18 In a preliminary study, we found that 48% of the patients with ALD admitted consuming any alcohol after transplantation, although a return to heavy drinking (Ͼ20 units/wk) was reported in only 15%.…”

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confidence: 99%

“…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. 10 One widely accepted reason for a fixed period of pretransplantation abstinence is that when these patients maintain complete abstinence from alcohol, many improve to the point that liver transplantation is not needed.…”

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confidence: 99%

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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%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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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“…Data from many centers have shown that liver transplantation is a successful treatment for this syndrome. [2][3][4][5][6][7] The main argument regarding the purpose of liver transplantation in ALD turns on a consideration of alcoholism rather than of liver disease itself. The debate is complicated by the fact that the number of potential recipients for liver transplantation greatly exceeds the number of available donor organs.…”

mentioning

confidence: 99%