Alcoholic Recidivism After Liver Transplantation for Alcoholic Cirrhosis

Fábrega, Emilio; Crespo, Javier; Casafont, Fernando; Heras, G. de las; Peña, J. de la; Pons‐Romero, F.

doi:10.1097/00004836-199804000-00011

Cited by 50 publications

(31 citation statements)

References 18 publications

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“…Poor post-OLT outcome has previously been noted in actively drinking patients (13). However, other studies have found no effect on graft and patient survival, nor compliance with immunosuppression despite recidivism rates estimated at 25% (14) and 32% (15), respectively. Reports of renal transplantation in former drug addicts have not shown a poor outcome; however, recidivism was not rigorously investigated in these studies (16).…”

Section: Discussionmentioning

confidence: 89%

Survival and Risk of Recidivism in Methadone-Dependent Patients Undergoing Liver Transplantation

Liu

Schiano

Lau

et al. 2003

American Journal of Transplantation

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Cirrhosis resulting from hepatitis C virus is presently the most common indication for liver transplantation (OLT) in the United States. A number of U.S. transplant centers require cirrhotics who are using methadone to discontinue it before proceeding with OLT. We sought to examine the outcomes of those patients who had undergone OLT at the Mount Sinai Medical Center.A retrospective chart review of 36 subjects on methadone maintenance treatment (MMT), and off heroin, at the time of OLT was performed.The median daily methadone dose pre-OLT was 50 mg. Post-OLT, there was an increase in methadone dose in 15 subjects, a decrease in four subjects, and no dose change in 17 subjects. Four subjects had documented single episodes of intravenous drug use post-OLT; only one subject had a dose change after the event. Patient and graft survival rates were comparable to the national average.There was no significant difference in post-OLT outcome in patients on MMT when compared with the general population. The few episodes of drug relapse were not related to changes in the methadone dose. Efforts should be made to allow methadoneusing cirrhotics better access to OLT without regard to methadone dosage.

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Section: Discussionmentioning

confidence: 89%

Survival and Risk of Recidivism in Methadone-Dependent Patients Undergoing Liver Transplantation

Liu

Schiano

Lau

et al. 2003

American Journal of Transplantation

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“…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%. The majority returned to drinking within 1 year.…”

mentioning

confidence: 88%

“…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.…”

mentioning

confidence: 99%

Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism

Mackie¹

2001

Liver Transplantation

159

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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“…O principal argumento utilizado era a grande probabilidade de que índices elevados de recidiva diminuíssem a sobrevida, quer pelo desenvolvimento de lesões graves no enxerto associadas ao etanol, quer por outros problemas médicos com uso inadequado de imunossupressores ou complicações associadas ao alcoolismo crônico. Muitos estudos a respeito da recidiva de consumo de álcool após o transplante hepático têm sido publicados na última década (7,10,14,15,17,23,25,28,32) . A maioria dos trabalhos demonstra taxas de recidiva ao redor de 12% a 50% (4,5,6,10,11,12,13,14,15,20,28) .…”

Section: Discussionunclassified

“…Muitos trabalhos têm mostrado resultados semelhantes (10,28) . Segundo MALDONADO e KEEFFE (23) , a maioria dos centros transplantadores ainda acredita que são necessários 6 meses de abstinência pré-transplante.…”

Section: Discussionunclassified

Recidiva da ingesta alcoólica em pacientes candidatos a transplante hepático: análise de fatores de risco

Vieira¹,

Rolim²,

Capua³

et al. 2007

Arq. Gastroenterol.

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e Luiz Arnaldo SZUTAN 2 RESUMO -Racional -A recidiva do consumo do álcool após transplante representa grande preocupação nos centros transplantadores e é objeto de debate e controvérsia. Objetivo -Avaliar a recidiva da ingesta alcoólica e eventuais fatores a ela relacionados, em pacientes cirróticos, referidos para transplante hepático. Métodos -Estudo retrospectivo de julho de 1995 a setembro de 2005 incluindo 90 pacientes adultos com cirrose hepática, listados para transplante. Os critérios de exclusão eram: ausência de 6 meses de abstinência, não liberação da equipe de psicologia. O diagnóstico da recidiva (ingesta de qualquer quantidade de bebida alcoólica) era feito com base nas informações contidas nos prontuários e fornecidas por contato telefônico. Resultados -A recidiva encontrada foi de 18,9%, que correspondeu a 14,6% do número total de homens e 62,5% do número total das mulheres. A raça, média das idades, classificação de disfunção hepática, tempo de etilismo, quantidade da ingesta alcoólica e realização ou não de transplante, não mostraram correlação significativa com a recidiva da ingesta alcoólica. A comparação tempo de abstinência e recidiva guardou relação inversamente proporcional. Conclusão -A recidiva da ingesta alcoólica é baixa. Sexo feminino e tempo de abstinência inferior a 1 ano têm influência sobre a recidiva da ingesta alcoólica. DESCRITORES -Cirrose hepática alcoólica. Transplante de fígado. Consumo de bebidas alcoólicas. Recidiva. INTRODUÇÃOA doença hepática é uma importante complicação provocada pelo álcool (21) . A expressão histológica reflete a instalação de lesões agudas, como a esteatose e a hepatite alcoólica, ou crônicas, como a hepatite crônica ativa, esclerose da veia centrolobular, cirrose e carcinoma hepatocelular (27) . A cirrose é uma significante causa de morbidade e mortalidade no mundo ocidental (11,24,34) . A abstinência tem importante papel em todas as formas de doença hepática alcoólica (34) , porém, quando a falência hepática se instala, o transplante de fígado é aceito como terapia mais eficaz (2,3,13,31,33) . Entretanto, até 1985, pacientes com doença hepática avançada, cuja causa era o álcool, raramente eram beneficiados pelo recurso terapêutico do transplante hepático. O pessimismo em relação a este procedimento baseava-se na crença de que os resultados do transplante eram inferiores aos obtidos em outras formas de doenças hepáticas, aliado ao temor da recidiva do consumo alcoólico após o transplante, resultando em dano sobre o enxerto (12) . Alguns autores acreditavam que as limitações do transplante, nesse tipo de paciente, ocorriam não só pela presença da doença hepática, mas também pelo comprometimento cerebral, miocardiopatia, deficiências vitamínicas múltiplas e anormalidades da musculatura. O alto potencial de complicações, muitas vezes pela não aderência ao uso das medicações imunossupressoras, associava-se a esses motivos (35) . Muitos centros relutavam em aceitar a idéia de transplantar fígado em pacientes alcoólatras, considerando todos os fatores a...

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Alcoholic Recidivism After Liver Transplantation for Alcoholic Cirrhosis

Cited by 50 publications

References 18 publications

Survival and Risk of Recidivism in Methadone-Dependent Patients Undergoing Liver Transplantation

Survival and Risk of Recidivism in Methadone-Dependent Patients Undergoing Liver Transplantation

Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism

Recidiva da ingesta alcoólica em pacientes candidatos a transplante hepático: análise de fatores de risco

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