Carbohydrate Deficient Transferrin for Detection of Alcohol Relapse After Orthotopic Liver Transplantation for Alcoholic Cirrhosis

Berlakovich, Gabriela; Windhager, Thomas; Freundorfer, Edith; Lesch, Otto Michael; Steininger, R.; Mühlbacher, Ferdinand

doi:10.1097/00007890-199905150-00006

Cited by 52 publications

(21 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given that postal questionnaires are insensitive tools to detect very low levels of alcohol exposure, 6 it is possible that even this figure of a 50% relapse rate is an underestimate of the true frequency of alcohol relapse in these patients. Recent studies using objective markers of alcohol relapse, such as urinary alcohol levels, 28 serum carbohydrate-deficient transferrin concentrations, 29,30 or the degree of fat in liver biopsy specimens, 31 also suggest a considerable underreporting of alcohol use after liver transplantation for ALD.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after liver transplantation for alcoholic liver disease

et al. 2000

View full text Add to dashboard Cite

There are few data on predictive factors for alcohol relapse or long-term functional outcome after liver transplantation for alcoholic liver disease (ALD). In all 56 surviving UK patients (47 men, 9 women; mean age: 51 years; range: 33 to 69 years) who underwent transplantation for ALD at King's College Hospital over a 10-year period, alcohol relapse and outcome were assessed by outpatient and casenote review and by postal questionnaire containing (1) the Nottingham Health Profile (NHP), (2) the ShortForm-36 (SF-36) Health Survey, and (3) a drug and alcohol questionnaire. At a median of 2.5 years (range: 0.5 to 10 years), 13 of the 47 respondents (28%) and 2 of the 9 nonrespondents (22%) had evidence of potentially harmful drinking (>3 units daily) at some time posttransplantation. An additional 13 patients admitted to drinking some alcohol at least once, corresponding to an overall relapse rate of 50%. The patients with harmful drinking (1) had started drinking regularly at a younger age (18 v 25 years; P ‫؍‬ .01), (2) began drinking heavily at a younger age (30 v 40 years; P ‫؍‬ .01), (3) had shorter pretransplantation abstinence periods (10 v 23 months; P ‫؍‬ .02), and (4) had a longer time since transplantation (median, 5.7 v 1.5 years; P ‫؍‬ .0004) than those with no or mild alcohol relapse. They were also more likely to report sleep disturbance (NHP sleep problem score, 45 v 16; P ‫؍‬ .01) and use benzodiazepines regularly (7 of 13 v 3 of 34 patients; P ‫؍‬ .002). Despite these differences, health dimension scores in the SF-36 and NHP posttransplantation were similar between the groups and to those of UK community controls. In the long term, at least 50% of the patients will drink again at some time posttransplantation, although at lower levels of alcohol intake than previously. Those patients with multiple predictive factors for alcohol relapse may be at greatest risk for harmful drinking and be the group that would benefit most from professional counseling. Overall, the quality of life after liver transplantation for ALD is high and broadly similar to the levels expected in the normal population. (Liver Transpl 2000;6:762-768.)O ne-year and 5-year survival rates after orthotopic liver transplantation for end-stage alcoholic liver disease (ALD) are similar to those for other chronic liver diseases. 1,2 Transplant recipients also show an improvement in mood state, cognitive functioning, and qualityof-life measures, with no such improvements in waiting-list controls. [3][4][5] In an early study from our unit of 20 patients who underwent transplantation for ALD, Howard et al 6 reported that scores in the Medical Outcomes Survey (a 20-item questionnaire to assess physical functioning, role and social functioning, mental health, health perceptions, and pain 7 ) were similar between those who underwent transplantation for ALD and nonalcoholic liver disease, similar findings to those of a recent American study. 8 However, few data exist on long-term functional outcome or alcohol relapse after liver transplantati...

show abstract

Section: Discussionmentioning

confidence: 99%

Quality of life after liver transplantation for alcoholic liver disease

et al. 2000

View full text Add to dashboard Cite

show abstract

“…In the posttransplant follow-up, the examinations performed by the specialist psychologist were supported by prospective CDT monitoring. Excellent sensitivity and specificity could be demonstrated [5], indicating reliable rates for alcohol relapse. CDT was reassesed frequently enough for monitoring of drinking behavior, as it can safely be stated impossible for patients suffering from alcohol relapse not to drink alcohol for 17days (half-life of CDT) before a pending clinical visit.…”

Section: Discussionmentioning

confidence: 87%

transplantation for alcoholic cirrhosis

et al. 2000

Self Cite

View full text Add to dashboard Cite

In recent years, alcoholic cirrhosis has been accepted as an indication for OLT, compliance of patients suffering from alcoholic cirrhosis is still under discussion, however. 118 patients who had undergone OLT for alcoholic cirrhosis were considered for analysis. The mean follow-up time of the study population was 53.7 k 38.9 months. Compliance was defined by 3 parameters: l . Sobriety. Fifteen (13 YO) out of 118 recipients suffered an alcohol relapse during the observation period. There was no difference between the groups with or without alcohol relapse concerning compliance with medication, incidence of rejection, or adherence to checkups. 2. Drug-compliance. Nineteen recipients (16 YO) were not within the target range with the immunosuppressive medication. Comparison of the compliant-and non-compliant groups produced a significant difference for late acute rejection, the other parameters being similar in the subgroups. 3. Adherence to appointments. Nearly all patients in the study population ( > 95 Yo) were compliant with both transplant and psychological appointments in the outpatient clinic. In conclusion, analysis of our data indicates that patients with OLT for alcoholic cirrhosis are compliant, although alcohol relapse occurs in 13 YO of recipients.

show abstract

“…In contrast, in patients with chronic liver disease CDT-TRI-SIALO (+) had a distinctly worse performance for the detection of recent alcohol consumption. Although some reports [24,25] found CDT-TRISIALO (+) useful even in patients with chronic liver disease, others [7,[26][27][28] showed a weak correlation of recent alcohol consumption with CDT levels only. Some authors reported a better positive predictive value for recent alcohol consumption with CDT-TRISIALO (+) than with γGT or MCV [7] whereas others found no advantage in using CDT-TRI-SIALO (+) than the latter markers of alcohol consumption.…”

Section: Discussionmentioning

confidence: 99%