Optimizing strategies to reduce alcohol consumption and relapses, improving abstinence in liver transplant recipients

Abstract

We have read with great attention and special interest the paper by Carrique and collaborators entitled: Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment with Low Rate of Relapse (1). In this prospective study, the authors initiated a pilot program to challenge the paradigm of the "6-month rule" of abstinence for patients with alcohol-related liver disease (ALD) requiring a transplant (2).This study is the first trial in North America to admit patients with acute and chronic decompensated liver disease, regardless of abstinence length, and give comprehensive addiction treatment prior to and after liver transplantation (LT) to lower the risk of relapse. This interesting study involved an in-depth examination of patients' alcohol use, social support, and psychiatric comorbidity, as well as the provision of pre-and post-transplantation addiction treatment. In this sense, the authors report how their relapse prevention therapy was provided directly to all patients deemed to meet the program's inclusion criteria and how biomarker testing for alcohol was used pre and post-transplantation.The final cohort informed in this study was 703 individuals fulfilling the program's criteria, 101 patients (14%) were listed for transplantation, and 44 (6.2%) received transplants. The results of this study show that there were no significant differences in survival rates between those receiving transplants through the pilot program compared with a control group with more than six months of abstinence. Three patients returned to alcohol use during an average post-transplantation followup period of 339 days. Although the follow-up period was relatively brief, no post-transplant deaths were attributable to reverting to alcohol intake.A recently published study on causes of death and survival in alcoholic cirrhosis patients undergoing LT (3) showed that at ten years, sepsis was the leading cause of death, accounting for 21.3 percent of all deaths, followed by graft failure (18.9%) and multiorgan failure (15.6%). Furthermore, the authors analyzed how pre-transplant clinical problems, such as viral infections and encephalopathy, influence the age at which the transplanted patient develops multiorgan failure. According to the authors, multiorgan failure is the primary cause of sudden death, with increased mortality over the first year following transplantation, followed by sepsis and graft failure.Carrique et al.(1) show in their data that younger age

Presence of KIR2DL2/S2, KIR2DL5, and KIR3DL1 Molecules in Liver Transplant Recipients with Alcoholic Cirrhosis Could Be Implicated in Death by Graft Failure

“…Since transplanted AC patients now have a higher survival rate, this liver condition is one of the best indications for LTs [2,4,5]. Despite this improvement, patients should have a thorough post-transplant risk assessment for rejection, virus recurrence, and alcoholic relapse to make extreme efforts to avoid patient death [1,6,7]. Much research has not been performed on the clinical and molecular mechanisms that lead to liver graft loss or death in AC patients, but it has been widely accepted that various factors can contribute to these outcomes [2,[8][9][10].…”

“…Since transplanted AC patients now have a higher survival rate, this liver condition is one of the best indications for LTs [ 2 , 4 , 5 ]. Despite this improvement, patients should have a thorough post-transplant risk assessment for rejection, virus recurrence, and alcoholic relapse to make extreme efforts to avoid patient death [ 1 , 6 , 7 ].…”