Liver transplantation for alcoholic liver disease: Evaluation of a selection protocol

Abstract

based on these parameters, the expected survival of our We have used a formal transplant protocol to select transplanted patients was calculated. Although we appatients with alcoholic liver disease (ALD) for transplied the model to a different population, the observed plantation. We retrospectively analyzed all the patients actuarial survival in the transplanted patients was with ALD who were referred specifically for transfound to be better than their expected survival (P°plantation to our Liver Unit between 1987 and 1994. Pa-.001). Our protocol was useful in selecting suitable patients were selected for liver transplantation if they had tients with ALD for liver transplantation, which resulted end-stage liver disease and had remained abstinent from in significant survival advantage with low recidivism the time they were medically advised to stop alcohol rate. (HEPATOLOGY 1997;25:1478-1484.) intake. Of the 180 patients referred for transplantation, 43 (none of whom were transplanted) had case records insufficiently complete for full analysis; this may bias Alcoholic liver disease (ALD) is currently the most common the analysis. Of the remaining 137 patients, 39 were indication for liver transplantation in the USA while it constitransplanted and 4 were awaiting transplantation at the tutes less than 5% of liver disease patients who receive transtime of analysis. Of the patients who were not accepted plantation in the UK. 1-3 Recent improvement in results of for transplantation, 13 died during the assessment, 7 liver transplantation for ALD 4,5 has left little doubt about the were considered to be unlikely to survive the procedure, value of this therapy for patients with end-stage alcoholic 29 were found to be medically unsuitable, 16 psychologi-cirrhosis; however, there is no consensus about the criteria cally unsuitable, 7 patients refused the offer of trans-needed to select the patient for this therapy and the ideal plantation, and an additional 19 either showed clinical timing for this procedure. 6,7 This is partly because of the fact improvement or were considered too well for trans-that natural history of this disease depends on patient's abilplantation. Special investigations, such as brain com-ity to abstain from alcohol. 8,9 Controversy also surrounds the puterized tomography (CT) scan and echocardiograph, ethical issues involved as some groups regard this disease as changed the clinical decision to transplant in only a largely self inflicted. 10,11 In the face of significant recidivism, small number of cases (4% and 5%, respectively). Nine of additional objections may come from a public that not only the transplanted patients died and the remaining were has indirectly to bear the high cost of liver transplantation followed up for a median of 25 (range, 7-63) months. One but also has to provide organs for this procedure. In the Oreyear actuarial survival for the transplanted patients was gon report, assessing the public opinion about the health care 79%, for those considered too sick was 0%, for medicall...

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

“…If these patients remain abstinent, their prognosis is superior to that of patients with liver cirrhosis of other etiologies. However, continued alcohol consumption is considered an absolute contraindication for LT. [1][2][3][4] Therefore, the high percentages of relapse cases before LT (19%-50%) 5,6 and after LT (11%-80%) [7][8][9][10][11][12][13][14][15][16][17][18][19][20] pose a serious problem. [21][22][23][24][25] To ensure abstinence by the patient, a strict and systematic investigation is required.…”

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

“…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.…”

“…22 Survival has been shown to be worse in patients who continued to drink postoperatively. 20 Therefore, for organs to be allocated most effectively, it seems particularly important to select patients who will do well postoperatively in terms of survival, as well as those who are likely to comply with follow-up and not return to a damaging pattern of alcohol consumption. Several studies have attempted to identify pretransplantation variables that may predict patients who will return to alcohol use.…”

Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups

“…11,12 The Béclère model is statistically more robust and more widely accepted in the transplant community than the alternative UK-based Birmingham model. 13 For the other two disease groups, models based either wholly or in part on UK cohorts were chosen. A mean of the Royal Free and European models was used to estimate shadow survival for the PBC group, 14,15,16 and a single model (international model) was used to estimate shadow survival for the PSC group.…”

“…17 The other models were applied to the data as part of a sensitivity analysis. 13,[18][19][20] To estimate shadow QALYs, shadow survival was weighted by patients' expected HRQL. Pretransplantation HRQL was estimated directly from each patient using the EQ-5D.…”