Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease

Abstract

The relevance of sobriety for outcome after orthotopic liver transplantation (OLT) for alcoholic liver disease (ALD) is still controversial. We conducted a retrospective analysis of 300 patients transplanted for ALD with regard to recurrent alcohol consumption, risk factors for drinking after OLT, and long-term survival. The 300 patients underwent OLT for ALD between 1989 and 2002. Median follow-up was 89 months. Incidence and severity of drinking, survival rates, and causes of death were assessed. Age, gender, duration of pretransplant sobriety, social support, presence of children, and the results of psychosomatic evaluation were analyzed for their impact on recurrent alcohol consumption after OLT. Drinking of various degrees was observed in 19% of ALD patients after OLT. Pretransplant sobriety of less than 6 months, absence of companion in life, presence of young children, and a predicted poor psychosomatic prognosis were associated with an increased risk of recurrent alcohol consumption, whereas age and gender were not independent risk factors. Survival rates of patients who resumed abusive drinking were significantly lower than survival rates of abstinent patients or patients with minor lapses. Recurrent alcoholic liver disease accounted for the vast majority of deaths among patients who resumed abusive drinking after OLT, whereas malignant tumors, infections, and cardiovascular disease were the most common causes of death among abstinent patients. In conclusion, abusive drinking after OLT is associated with poor long-term survival. Analysis of risk factors may help to identify patients with a high risk for recurrent alcohol abuse after OLT. Liver Transpl 13:197-205, 2007.

Liver Transplantation for Alcohol-Related Liver Disease

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in Table 2. Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family.…”

“…Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family. 11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse.…”

“…11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse. In a study of 118 patients by Rodrigue et al, 31 the authors advised a scoring system (Alcohol Relapse Risk Assessment) to predict risk of relapse.…”

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in …”

Liver Transplantatation- an Overview

“…This evaluation is critical for patients with alcoholic liver disease. The ability to abstain from alcohol after transplantation is predicted by the ability to abstain before transplantation for at least 6 months [7], and a family and friend support structure.…”