Liver transplantation for alcoholic liver disease: Executive statement and recommendations

Hoofnagle, Jay H.; Kresina, Thomas F.; Fuller, Richard K.; Lake, Julie; Lucey, Michael R.; Sorrell, Michael F.; Beresford, Thomas P.

doi:10.1002/lt.500030324

Cited by 61 publications

(25 citation statements)

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“…The diagnosis of alcoholic liver disease is no longer an absolute contraindication to LT. Contrary to previous thinking, graft and patient survival in alcoholic liver disease is similar to that seen in patients transplanted for nonalcoholic liver disease 1, 2, 5, 6. However, alcohol relapse continues to be of concern in these patients.…”

Section: Discussionmentioning

confidence: 63%

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Analysis of factors that predict alcohol relapse following liver transplantation

Jauhar

Talwalkar²,

Schneekloth

et al. 2004

Liver Transpl

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Alcoholic liver disease has become a major indication for liver transplantation in the United States. Factors that predict alcohol relapse after liver transplantation are poorly defined. The aim of our study was to identify predictors of alcohol relapse in patients undergoing liver transplantation for alcoholic liver disease. One hundred and eleven patients undergoing liver transplantation for alcoholic liver disease between 1985 and 1999 were identified from our database. Patients were selected for liver transplantation if their risk of relapse was felt to be low by the transplant team. A chart review was conducted to determine if relapse had occurred, the presence or absence of factors that were thought to predict relapse, and survival. Demographic and psychosocial variables were analyzed using univariate and multivariate logistic regression to identify independent predictors of relapse. The median duration of abstinence before liver transplantation was 15 months (range: 1-120). Hepatitis C virus was present in 64% of patients. A family history of alcoholism in a firstdegree relative was identified in 38%, and 78% received treatment for alcoholism before liver transplantation. The mean duration of follow-up was 44.1 ؎ 3.7 months. There were 29 deaths (26%) overall. Seventeen patients (15%) returned to alcohol use. On multivariate analysis a family history of alcoholism was found to be an independent predictor of alcohol relapse (P‫؍‬ .03). Further prospective studies are needed to examine this association in greater detail to provide targeted treatment for alcoholism both before and after liver transplantation. A lcoholic liver disease is the second leading indication for liver transplantation (LT) in the United States. 1,2 Between 1988 and 1995, approximately 23% of liver transplants were carried out for alcohol-related liver disease. 1 There has been much debate over allocation of organs to persons with alcoholic liver disease and transplant centers generally have local criteria for patient selection. 3 In addition, many transplant centers require that patients be abstinent for at least 6 months before being registered for liver transplantation. Despite a large number of studies examining risk factors, no reliable factor, including 6 months of pretransplant abstinence, has been found to consistently predict relapse to alcohol in patients undergoing LT for alcoholic liver disease. The aim of our study was to determine the role of demographic and psychosocial factors in predicting relapse to alcohol after LT for alcoholic liver disease. Patients and MethodsPatients undergoing LT for alcohol-related liver disease between 1985 and 1999 at the Mayo Clinic in Rochester, MN comprised the study population. All patients were diagnosed with alcohol dependence or alcohol abuse by a psychiatrist, using Diagnostic and Statistical Manual of Mental Disorders (DSM) IIIR and IV criteria 4 or were determined to have alcoholic liver disease by their primary hepatologist based on the history, physical examination, and laborator...

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Section: Discussionmentioning

confidence: 63%

“…Alcoholic liver disease is the second leading indication for liver transplantation (LT) in the United States 1, 2. Between 1988 and 1995, approximately 23% of liver transplants were carried out for alcohol‐related liver disease 1.…”

mentioning

confidence: 99%

Analysis of factors that predict alcohol relapse following liver transplantation

Jauhar

Talwalkar²,

Schneekloth

et al. 2004

Liver Transpl

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“…Five percent of the deaths occur ring annually in the United States (approximately 100 000 per year) are either directly or indirectly attributable to alcohol abuse [12] . In 1994, approximately 7.4% of adult Americans met the DSMIV criteria for the diagnosis of alcohol abuse and/or alcohol dependence [44] .…”

Section: Global and Economic Burdenmentioning

confidence: 99%

“…Traditionally, drinking is considered harmful if alcohol use impacts the daily functioning and/or social life of the in dividual such as loss of job, accident, loss of family mem ber, or death [11] . About 10% of the population consumes more than two drinks per day, which is a commonly used definition of "heavy drinking" [12] . However, substantial dif ferences exist in the prevalence of heavy drinking among population subgroups.…”

Section: Amount Of Alcohol Intakementioning

confidence: 99%

Definition, epidemiology and magnitude of alcoholic hepatitis

Basra¹

2011

WJH

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Alcoholic liver disease (ALD) is a major cause of alcohol-related morbidity and mortality. Its presentation ranges from fatty liver to alcoholic hepatitis (AH), cirrhosis, and hepatocellular carcinoma. Although the amount and pattern of alcohol consumption is a well recognized predisposing factor for the development of serious liver pathology, environmental factors and the host's genetic make-up may also play significant roles that have not yet been entirely explored. Continuing alcohol consumption is a major factor that influences the survival of patients with AH. The presence of cirrhosis at presentation or its development on follow up is a major factor determining the outcome in the long run. This chapter deals with the epidemiology and magnitude of ALD in general and AH in particular.

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“…Current evidence supports ALD as an appropriate indication for liver transplantation, as highlighted by well‐documented data suggesting that patients with ALD have similar graft and patient survival outcomes as patients who undergo transplantation for non‐ALD5, 12 and incur no increase in cost or resource utilization 13, 14. The cumulative experience of multiple transplant centers have confirmed that the 1‐year and 5‐year actuarial survival rates following liver transplantation are similar for patients with ALD and non‐ALD in both US and European liver registries.…”

Section: Questions Regarding Transplantation For Aldmentioning

confidence: 99%

Liver transplantation for alcoholic liver disease: Current concepts and length of sobriety

2004

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Liver transplantation for alcoholic liver disease: Executive statement and recommendations

Cited by 61 publications

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Analysis of factors that predict alcohol relapse following liver transplantation

Analysis of factors that predict alcohol relapse following liver transplantation

Definition, epidemiology and magnitude of alcoholic hepatitis

Liver transplantation for alcoholic liver disease: Current concepts and length of sobriety

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