Transplantation for alcoholic liver disease: Report of a consensus meeting

Webb, Kerry; Shepherd, Liz; Day, Ed; Masterton, George; Neuberger, James

doi:10.1002/lt.20681

Cited by 30 publications

(19 citation statements)

References 29 publications

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“…However, the number of potentially relevant non‐English reports was minute relative to the number of reports reviewed for possible inclusion. We have already noted other limitations that reflect the areas of focus and omission within the body of research that we synthesized: 1) little consideration of samples beyond liver transplantation; 2) beyond substance use outcomes, consideration of nonadherence in only a narrow range of the components of the medical regimen; 3) examination of psychosocial variables only in relation to relapse to any alcohol use, despite calls for the literature to focus on heavy or harmful use7, 8, 14; 4) inability to examine associations between posttransplantation substance use relapse and medical regimen adherence because too few studies examined such effects; and 5) inability to examine many variables proposed to be important predictors of substance use relapse (e.g., whether past substance use met criteria for dependence vs. abuse, presence of personality disorder) because too few studies have included them. Indeed, these areas of focus and omission in the literature provide a roadmap for work in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Organ transplantation has become an increasingly accepted strategy for the treatment of end‐stage diseases associated with substance abuse or dependence. For example, despite early reservations as to whether patients with alcoholic liver disease were appropriate transplant candidates,1–4 alcoholic liver disease is now among the most common indications for liver transplantation in both the United States and Europe,5–8 and short‐term (1‐5 yr) survival rates for these patients are similar to or exceed those of patients receiving transplantation for other types of liver disease 5, 9. A small literature suggests that favorable outcomes are also possible for liver and other solid organ transplant recipients with histories of other types of substance abuse (e.g., heroin use) 10–13…”

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confidence: 99%

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Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs

et al. 2008

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For patients receiving liver or other organ transplants for diseases associated with substance use, risk for relapse posttransplantation is a prominent clinical concern. However, there is little consensus regarding either the prevalence or risk factors for relapse to alcohol or illicit drug use in these patients. Moreover, the evidence is inconsistent as to whether patients with pretransplantation substance use histories show poorer posttransplantation medical adherence. We conducted a meta-analysis of studies published between 1983 and 2005 to estimate relapse rates, rates of nonadherence to the medical regimen, and the association of potential risk factors with these rates. The analysis included 54 studies (50 liver, 3 kidney, and 1 heart). Average alcohol relapse rates (examined only in liver studies) were 5.6 cases per 100 patients per year (PPY) for relapse to any alcohol use and 2.5 cases per 100 PPY for relapse with heavy alcohol use. Illicit drug relapse averaged 3.7 cases per 100 PPY, with a significantly lower rate in liver vs. other recipients (1.9 vs. 6.1 cases). Average rates in other areas (tobacco use, immunosuppressant and clinic appointment nonadherence) were 2 to 10 cases per 100 PPY. Risk factors could be examined only for relapse to any alcohol use. Demographics and most pretransplantation characteristics showed little correlation with relapse. Poorer social support, family alcohol history, and pretransplantation abstinence of Յ6 months showed small but significant associations with relapse (r ϭ 0.17-0.21). Future research should focus on improving the prediction of risk for substance use relapse, and on testing interventions to promote continued abstinence posttransplantation. Liver Transpl 14: 159-172, 2008.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs

et al. 2008

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“…Alcoholic recidivism has been considered to negatively impact postoperative compliance and long-term outcomes of recipients [21,[24][25][26][27][28][29][30] . This perception may have encouraged LT professionals to evaluate predictive factors for alcoholic recidivism and therefore, to require specific criteria for ALD patients to prevent alcoholic recidivism in addition to commonly applied criteria.…”

Section: Alcoholic Recidivismmentioning

confidence: 99%

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Kawaguchi¹,

Sugawara²,

Akamatsu³

et al. 2014

WJH

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“…Although chronic alcohol abuse is the underlying cause for transplantation in ALD patients, a considerable number (∼20‐25%) return to harmful drinking after the operation 5, 6. Alcohol recidivism after transplantation may lead to a reduced long‐term survival rate 7–9. Activities to promote abstinence from alcohol in ALD transplant patients are therefore highly recommended 9…”

mentioning

confidence: 99%

“…Alcohol recidivism after transplantation may lead to a reduced long‐term survival rate 7–9. Activities to promote abstinence from alcohol in ALD transplant patients are therefore highly recommended 9…”

mentioning

confidence: 99%

Urinary ethyl glucuronide testing detects alcohol consumption in alcoholic liver disease patients awaiting liver transplantation

Erim

Böttcher²,

Dahmen

et al. 2007

Liver Transpl

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This study compared measurement of urinary ethyl glucuronide (EtG), a conjugated minor ethanol metabolite with a longer detection window than ethanol itself, with breath alcohol testing and self-report as ways to disclose recent drinking by 18 liver transplant candidates with an alcoholic liver disease diagnosis that underwent an addiction group therapy program. At each therapy session, patients were questioned about any alcohol consumption in the intervening time, and they also performed a mandatory breath alcohol test, while observed urine samples for measurement of EtG were delivered on a voluntary basis. None of the patients ever admitted to intake of alcohol, and only 1 of 127 breath alcohol tests turned out positive. However, 9 patients showed positive EtG results in 24 (49%) of 49 urine samples. The individual frequency of urine samples being positive for EtG ranged from 22% to 100% with a mean value of 57%. Because 6 patients refused to provide urine on a total of 18 occasions, alcohol use might have been even more common. These results underscore the uncertainty of self-report data and the low sensitivity of breath alcohol testing as ways to disclose recent drinking, and underline the necessity of introducing sensitive and specific objective measures of recent alcohol consumption, such as EtG, in the transplantation setting. Liver Transpl 13:757-761, 2007.

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Transplantation for alcoholic liver disease: Report of a consensus meeting

Cited by 30 publications

References 29 publications

Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs

Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Urinary ethyl glucuronide testing detects alcohol consumption in alcoholic liver disease patients awaiting liver transplantation

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