Outcomes after liver transplantation for combined alcohol and hepatitis C virus infection

Abstract

Alcohol abuse and chronic hepatitis C virus (HCV) infection are two major causes of chronic liver disease in the United States. About 10%-15% of liver transplants performed in the United States are for patients with cirrhosis due to combined alcohol and HCV infection. Data on outcomes on graft and patient survival, HCV recurrence, and relapse of alcohol use comparing transplants in hepatitis C positive drinkers compared to alcohol abuse or hepatitis C alone are conflicting in the literature. Some studies report a slightly better overall outcome in patients who were transplanted for alcoholic cirrhosis vs those transplanted for HCV alone or for combined HCV and alcohol related cirrhosis. However, some other studies do not support these observations. However, most studies are limited to a retrospective design or small sample size. Larger prospective multicenter studies are needed to better define the outcomes in hepatitis C drinkers.

Functional Status at Liver Transplant Waitlisting Correlates With Greater Odds of Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis

“…The increased availability of highly effective direct-acting antivirals may have since limited mortality in the HCV waitlist population compared with that of other cirrhosis etiologies. 18,19 Compared with HCV and alcoholic liver disease by themselves, HCV + AC produces more aggressive disease through synergistic effects, leading to greater waitlist mortality, 20,21 albeit it would be reasonable to assume that patients that have registered on the LT waitlist have demonstrated alcohol abstinence.…”