Alcohol use after liver transplantation in alcoholics: A clinical cohort follow-up study

Abstract

present in posttransplant biopsies from 1 alcohol user The purposes of this study were to determine among only. Alcohol use by alcoholics is uncommon in the first 5 a cohort of long-term alcoholic survivors after liver years after liver transplantation, and alcohol-associated transplantation (1) the incidence of alcohol use, (2) its liver injury is unusual. Mild nonspecific hepatitis is comeffect on allograft integrity and extrahepatic health, and mon in both alcohol users and nonusers alike. Orthotopic liver transplantation is an efficacious therapy center. Fifty alcoholic, long-term liver transplant recipi-for severe liver failure associated with alcoholism. Survival ents. The frequency of alcohol relapse, defined as any rates after liver transplantation are similar among alcoholics alcohol use in the period after transplantation, was de-and nonalcoholics.1,2 There is a significant survival advantermined by two questionnaire studies and by clinical tage among alcoholics with transplants compared with alcofollow-up. Allograft integrity was assessed by coded re-holic patients refused transplants on psychiatric grounds or view of serial percutaneous allograft biopsies. Potential compared with alcoholic controls with severe liver disease in systemic effects of alcohol relapse were assessed by a simulated mathematical model. 2,3 We have shown that chart review. The alcohol prognosis screening process more than 50% of alcoholics referred to our program are rewas evaluated by retrospectively comparing pretrans-fused transplants on either medical, surgical, or psychiatric plant estimates of putative indicators of alcoholism grounds, a rate of refusal that exceeds that for most other prognosis in posttransplant alcohol users and abstain-chronic liver diseases (unpublished observations). ers. Thirty-three recipients (66%) consistently deniedAlcoholics with end-stage liver disease undergo careful asany alcohol use throughout the duration of posttrans-sessment of the risk of recidivism in the future. 4 There is a plant follow-up, whereas 17 (34%) were identified as hav-relatively low incidence of recidivism in short-term periods ing consumed alcohol at least once since the transplant. of observation after transplantation.2,5-8 More recent studies There were no significant differences at the time of eval-have suggested that the incidence of recidivism, although uation between abstainers and alcohol users in age, sex still low compared with incidence with other forms of therapy distribution, severity of liver dysfunction, median dura-for alcoholism, increases with longer follow-up. tion of abstinence, or University of Michigan alcoholismIt remains uncertain whether alcohol use after liver transprognosis score. The median interval from transplanta-plantation has untoward consequences for allograft function. tion to alcohol relapse was 17 months, with a range of 3 Indeed, Bonet et al. have proposed that a relapse of alcohol to 45 months. Recurrent alcohol use was associated with abuse by alcoholics after liver transplantation...

Liver transplantation

“…57 Although complete abstinence rates vary considerably from center to center, graft loss as a consequence of destructive drinking after transplantation is uncommon. [58][59][60][61] More than 85% of the transplant programs in the United States require 6 months of abstinence before transplantation, and careful evaluation by professional counselors is important to directly address the addiction to alcohol. 62 Successful completion and adherence to a formal treatment program may be necessary.…”

Resultados do transplante de fígado na doença hepática alcoólica

“…Muitos estudos a respeito da recidiva do consumo de álcool após o TH têm sido publicados na última década (2,6,7,8,9,10,11,13) . A maioria deles são estudos retrospectivos, com períodos relativamente curtos de acompanhamento (geralmente inferior a 5 anos) e número pequeno de pacientes.…”

“…Em 1988, STARZL et al (15) , avaliando 41 pacientes com cirrose alcoólica avançada submetidos a TH na Universidade de Pittsburgh, sob esquema de imunossupressão com ciclosporina, relataram sobrevida em 1 ano de 73,2% e em 3 anos de 68%. Índices satisfatórios de sobrevida em 1 ano pós-TH em portadores de DHA, variando de 66% a 100%, também foram documentados em outros centros americanos e europeus (1,2,5,7,8,9,10,13,14,16) .…”

“…A freqüência com que a recidiva de consumo de bebidas alcoólicas é detectada no acompanhamento pós-transplante é variável, dependendo em parte dos métodos empregados na avaliação e seleção dos candidatos na fase pré-transplante, bem como dos métodos empregados para tal rastreamento dessa complicação no pós-transplante. Publicações relatando a experiência de diferentes centros transplantadores apontam para índices de recidiva em torno de 12% a 50% (2,6,7,8,9,10,11,13) . A necessidade de intervalo de abstinência pré-TH tem sofrido reavaliações, mas a maioria dos centros de transplante adota mínimo de abstinência de pelo menos 6 meses antes do TH.…”

Issues in selection for and outcome of liver transplantation in patients with alcoholic liver disease

“…Recurrence of alcoholism, however defined, is rarely fatal in the first 5 years after liver transplantation. 13 Consequently, the return to drinking by the alcoholic liver transplant recipient, except in those rare cases in which renewed alcohol use is associated with graft failure, is more analogous to chronic viral hepatitis than to recurrent hepatoma. It is important to establish this contextual basis to consider the significance of drinking after liver transplantation because predicting future drinking behavior has become a significant component of pretransplant evaluation of alcoholics.…”