Alcohol Use after Liver Transplantation is Independent of Liver Disease Etiology

Abstract

Aim: To assess alcohol use after liver transplantation (LT) and compare liver transplant recipients for alcoholic liver disease (ALD) with recipients for non-ALD causes. Methods: National Institute of Diabetes and Digestive and Kidney Diseases liver transplant database stratified to ALD and non-ALD causes. Results: Among 488 LT recipients reporting pre-transplant alcohol use (147 ALD), proportion of LT recipients reporting alcohol use was similar comparing ALD and non-ALD transplants (25.4% vs. 27.2%; P = 0.56). Among ALD transplants, of 31 with alcohol use, 23 (74%) relapsed at ≥2 year, 25 (80%) reported intermittent drinking and 4 (13%) reported heavy drinking. Among Non-ALD recipients, alcohol use was equally distributed to within 2, 2-5 and after 5 years of LT with 82% reporting intermittent drinking and 9% heavy drinking. Patients with pre-transplant drinking of >20 years and abstinence duration of <2 years were over 2.5-fold likely to report post-transplant alcohol use compared to drinking of >20 years and abstinence of >2 years, 2.56 [95% CI: 1.41-4.67]. Etiology (ALD vs. non-ALD) did not predict post-transplant alcohol use. Of 139 ALD patients with follow-up biopsy data, 13 (7 with post-transplant alcohol use) had steatohepatitis. Histology on 319 non-ALD recipients showed recurrent disease in 91, none due to alcohol. Overall survival was similar between drinkers and abstainers (71% vs. 66%; P = 0.35). Recurrent ALD was cause of death in one ALD and none of non-ALD patients. Conclusion: Alcohol use after LT is independent of LT indication. Patients with non-ALD etiology should be carefully screened for alcohol use prior to LT to identify those at risk for post-LT alcohol use.

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

“…Alcohol addiction is considered a big problem after LT, while moderate alcohol consumption is underestimated by both patients and their healthcare providers. Sometimes there is even a recommendation to carefully assess the alcohol consumption of patients on LT waiting lists who have non-AC cirrhosis[ 40 , 41 ].…”

“…This immunosuppressive treatment can lead to a risk of de novo malignancy that is 2-7-fold higher than usual after adjusting for age and gender, and 5- and 10-year incidence rates are estimated to be 10%-14.6% and 20%-32%, respectively[ 42 , 43 ]. Moderate alcohol consumption can have a negative effect on LT as it increases the risk of liver fibrosis, mainly in women, even if alcohol consumption is < 12 g/d[ 40 - 43 ].…”

How I treat… alcohol-related liver disease

“…28 Alcohol use post-transplant is independent of the indication for the liver transplant. 30 In common with other aetiologies of end stage liver disease, significant milestones in a patient's clinical course (development of hepatic encephalopathy, development of ascites, first decompensation) and a qualifying United Kingdom Model for End-Stage Liver Disease score should prompt consideration of referral to a transplant centre for patients with ARLD who have shown a commitment to alcohol abstinence.…”

Alcohol Induced Fatty Liver: A Tragic Inception of Wrong Turn

“…Severe alcoholic hepatitis patients nonresponsive to steroids have a 3 months mortality rate of 70% and with HRS the mortality rate is ≥ 90% unless the patients get liver transplantation [74]. Alcohol consumption can complicate a patient's health after LT, as it increases the risk of liver fibrosis, mainly in women, even if alcohol consumption is < 12 g/d [75]. Alcohol relapse after LT is not uncommon and is reported to occur in 10% to 60% of recipients of LT for ALD [76].…”