Orthotopic Liver Transplantation for Alcoholic Liver Disease

Abstract

Alcohol abuse is the most common cause of end-stage liver disease in the United States, but many transplant centers are unwilling to accept alcoholic patients because of their supposed potential for recidivism, poor compliance with the required immunosuppression regimen and resulting failure of the allograft. There is also concern that alcohol-induced injury in other organs will preclude a good result. From July 1, 1982, to April 30, 1988, 73 patients received orthotopic liver transplants at the University of Pittsburgh for end-stage alcoholic liver disease. Fifty-two (71%) of these were alive at 25 +/- 9 mo (mean +/- S.D.) after transplantation, when a phone survey of these patients, their wives/husbands, and their physicians was performed to evaluate their subsequent use of alcohol, current medical condition and employment. Data obtained were compared with those for nonalcoholic patients selected as transplant controls. The recidivism rate has been 11.5%, with most patients drinking only socially. Fifty-four percent of the survivors are employed, 21% classify themselves as homemakers and only 11 (21%) are unable to work. Twenty-one patients died after transplantation; the most frequent cause of death was sepsis (43%), and intraoperative death was the next most common cause (28.6%). These data demonstrate that alcoholic patients can be transplanted successfully and achieve good health not significantly different from that of individuals transplanted for other causes. Thus orthotopic liver transplantation is a therapeutic option that should be considered for individuals with end-stage alcoholic liver disease who desire such therapy.

Resultados do transplante de fígado na doença hepática alcoólica

“…Em 1988, STARZL et al (15) , avaliando 41 pacientes com cirrose alcoólica avançada submetidos a TH na Universidade de Pittsburgh, sob esquema de imunossupressão com ciclosporina, relataram sobrevida em 1 ano de 73,2% e em 3 anos de 68%. Índices satisfatórios de sobrevida em 1 ano pós-TH em portadores de DHA, variando de 66% a 100%, também foram documentados em outros centros americanos e europeus (1,2,5,7,8,9,10,13,14,16) .…”

“…A freqüência com que a recidiva de consumo de bebidas alcoólicas é detectada no acompanhamento pós-transplante é variável, dependendo em parte dos métodos empregados na avaliação e seleção dos candidatos na fase pré-transplante, bem como dos métodos empregados para tal rastreamento dessa complicação no pós-transplante. Publicações relatando a experiência de diferentes centros transplantadores apontam para índices de recidiva em torno de 12% a 50% (2,6,7,8,9,10,11,13) . A necessidade de intervalo de abstinência pré-TH tem sofrido reavaliações, mas a maioria dos centros de transplante adota mínimo de abstinência de pelo menos 6 meses antes do TH.…”

Drink for thought: A mediterranean experience Pro-liver transplantation in alcoholic cirrhosis

“…3 We find that many times it is not the surgical threat, or the magnitude of the procedure itself, but the whole process of medical support, which includes invasive procedures to investigate comorbid conditions. If the postoperative abstinence may be related to the regimentation that is required after transplantation, 4 we think that all that is done before is really the key life event that is able to change its course.…”

“…4 However, and this is rarely needed in our experience, it is essential to be absolutely sure of sustained abstinence through personal and familial interviews or with the not so satisfactory biochemical markers of alcohol use.…”

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

“…Data from many centers have shown that liver transplantation is a successful treatment for this syndrome. [2][3][4][5][6][7] The main argument regarding the purpose of liver transplantation in ALD turns on a consideration of alcoholism rather than of liver disease itself. The debate is complicated by the fact that the number of potential recipients for liver transplantation greatly exceeds the number of available donor organs.…”