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

Lucey, M. R.

doi:10.1002/lt.500030306

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…30 A major issue in maintaining excellent outcomes in this patient population is identifying candidates with a low risk of recidivism after transplantation because alcohol abuse after liver transplantation can result in rapid development of cirrhosis in the graft, interfere in the compliance and bioavailability of immunosuppressive medications, and alter the perceptions of the general public and potential organ donors in a detrimental way. 31 Most studies suggest that alcohol relapse after transplantation occurs in 15% to 30% of patients. 32 Although this figure may be low because many patients do not admit to relapse, the low incidence of observed graft injury and loss due to recurrent alcoholic liver disease suggest that most of these patients do not drink alcohol to an extent that is detrimental to their graft and health.…”

Section: Liver Transplantationmentioning

confidence: 99%

Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease

Menon

Gores

Shah

2001

Mayo Clinic Proceedings

128

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Alcohol-related liver disease is a major cause of morbidity and mortality in the United States. Alcoholic liver disease encompasses a clinicohistological spectrum, including fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is a benign and reversible condition, but progression to alcoholic hepatitis and cirrhosis is life-threatening. Alcoholic hepatitis is diagnosed predominantly on clinical history, physical examination, and laboratory testing, although liver biopsy is often necessary to secure the diagnosis. The major focus of management is abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Corticosteroid therapy is controversial but should be considered in patients with a discriminant function greater than 32 and/or presence of spontaneous hepatic encephalopathy in the absence of infection, gastrointestinal bleeding, and renal failure. The only curative therapy for advanced alcoholic cirrhosis is liver transplantation. Several recent advances in understanding the pathogenesis of alcoholic liver disease may lead to novel future treatment approaches, including inhibition of tumor necrosis factor a, antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.

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Section: Liver Transplantationmentioning

confidence: 99%

Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease

Menon

Gores

Shah

2001

Mayo Clinic Proceedings

128

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“…However, recent data suggest that recidivism rates may increase with longer follow-up (146), increasing from 15% at 1 yr to 31% at 3 yr posttransplant. Some studies have found that the rate of recidivism may be related to the duration of abstinence before liver transplantation (137,138,141,147), but this remains controversial (142,150). It should be emphasized that it is difficult to accurately diagnose alcohol consumption and that patients who have been transplanted for nonalcoholic liver disease have shown rates of alcohol use ranging from 24% to 46% (145,147,148).…”

Section: Liver Transplantationmentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

O’Connor

1998

American Journal of Gastroenterology

229

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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“…In 1997, an American consensus suggested that patients with AC should have a minimum abstinence period of 6 mo before being included on the LT waiting list, the so-called “6-mo rule.” The rationale of this recommendation was to evaluate the improvement of liver function, commonly observed after three to 6 mo of sobriety[ 140 , 141 ]. This abstinence period also serves as a predictor of post-transplant recurrence.…”

Section: Management Of Alcohol Addiction Before Ltmentioning

confidence: 99%

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

Ca¹,

Am²,

Sa³

et al. 2018

WJG

121

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Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

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

Cited by 12 publications

References 9 publications

Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease

Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

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

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