Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Kawaguchi, Yoshikuni; Sugawara, Yasuhiko; Akamatsu, Nobuhisa; Kaneko, Junichi; Tanaka, Tomohiro; Tamura, Sumihito; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

doi:10.4254/wjh.v6.i11.812

Cited by 5 publications

(4 citation statements)

References 52 publications

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“…Relapse is regarded as a kind of betrayal of the donor's sacrifice. The results are similar to those obtained for non-ALD patients and that of deceased donor LT and the relapse was 8% (5.7% with the rule and 19.1% without) [37][38][39]. From this conservative standpoint, the alcoholic hepatitis is still not indicated for LDLT [37][38][39].…”

supporting

confidence: 91%

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Management of alcohol recurrence before and after liver transplantation

Marroni

2015

Clinics and Research in Hepatology and Gastroenterology

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supporting

confidence: 91%

“…In Asia, ALD had not been regarded as an optimal indication for living donor liver transplantation (LDLT), because of the perception of a self-inflicted nature of ALD and the risk of relapse. Otherwise, there is a special relationship between the recipient and living donor considered unique, permitting LDLT in selected patients [37][38][39].…”

mentioning

confidence: 99%

Management of alcohol recurrence before and after liver transplantation

Marroni

2015

Clinics and Research in Hepatology and Gastroenterology

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“…Not denying the importance of better selection criteria for ALD patients, it seems unrealistic to apply all of them in a situation of life-threatening disease decompensation. Moreover, according to some authors, recidivism to harmful drinking connected with liver damage and graft loss is not very high and usually does not exceed 20%, which is similar to liver failure in some other recurrent diseases [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Alcohol Relapse After Liver Transplantation: Younger Women Are at Greatest Risk

Zeair¹,

Cyprys²,

Wiśniewska

et al. 2017

Ann Transplant

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BackgroundAlcoholic cirrhosis is an indication for 40% of liver transplantations (LT) in Europe. In most centers, 6 months of abstinence is required before listing. However, alcohol recidivism is quite high after LT, and approximately 20–25% of recipients with ALD resume harmful drinking, resulting in liver insufficiency, which casts doubt on the 6-months rule as a reliable marker of abstinence maintenance after LT.Material/MethodsWe analyzed data on patients who underwent orthotopic LT in Marie Curie Hospital, Szczecin, Poland, from 2000 to 2015 due to alcoholic or cryptogenic cirrhosis. Every ALD patient met the 6-month abstinence requirement. Alcohol recidivism has been studied based on a history of alcohol abuse taken from the patients or from their relatives, and in case of denial, on laboratory tests for alcohol abuse. Five patterns of recidivism were distinguished: death, constant heavy drinking, heavy drinking with abstinence attempts, occasional laps, and a single episode of alcohol intake. The analysis of survival was performed according to the Kaplan-Meier method. Patient survival rates in ALD recipients vs. non-ALD recipients were compared using the log-rank test.ResultsAlcohol recidivism was finally evaluated in 109 patients: 81 males and 28 females, with a median age of 53.3 years (range 30–66). Harmful drinking was discovered in 16 patients (14.7%), including seven deaths due to alcoholic hepatitis. Sporadic or episodic drinking was found in 29 patients (27%). In heavy drinkers, the abstinence period after transplantation was significantly shorter and patients were younger than the average (median age 43.8 years). Women break abstinence faster than men and are at greater risk of liver insufficiency. Five, 10 and 15-year survival in the ALD group was superior in comparison with non-ALD group, but differences did not reach statistical significance (p=0.066, p=0.063, p=0.075, respectively).ConclusionsThe prognostic value of a 6-month abstinence period before transplantation is rather low as it does not predict sobriety after transplantation. However, only a minority of such patients drink harmfully. Survival in ALD recipients tends to be better in comparison with survival in the other etiologies. Younger women dependent on alcohol shortly before LT are at greatest risk of recidivism.

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“…The issues of recidivism and disease recurrence remain a concern in LT for alcoholic liver disease. Alcohol relapse negatively impacts outcomes including graft rejection and graft loss from poor medical compliance, post-transplant malignancy, cardiovascular diseases, alcoholic cirrhosis, and decreased long-term survival [8–11]. An abstinence period of at least 6 months before LT is a mandatory selection criterion in most liver transplant centers, but the benefit of such pre-transplant 6 month abstinence remains unclear [8, 12, 13].…”

Section: Introductionmentioning

confidence: 99%

Alcohol relapse and its predictors after liver transplantation for alcoholic liver disease: a systematic review and meta-analysis

et al. 2019

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Background Alcoholic liver disease (ALD) is the leading cause of liver transplantation (LT). The magnitude and risk factors of post-LT alcohol relapse are not well described. We conducted a meta-analysis to evaluate alcohol relapse rate and its predictors after LT. Methods Searches of MEDLINE and SCOPUS identified eligible published studies of alcohol relapse after LT published up to 31 March 2018. Alcohol relapse was defined as any alcohol consumption post-LT, and heavy alcohol relapse was defined as a relapse of alcohol consumption that was associated with a significant harm. Data for the proportion of alcohol relapse was pooled using a meta-analysis for pooling proportion. An odds ratio (OR) of the predictor of alcohol relapse was extracted and pooled using meta-analysis for the pooling risk factor. Data were analyzed using a random effect model if heterogeneity was presented; otherwise, a fixed effect model was applied. The study was registered at PROSPERO (CRD42017052659). Results Ninety-two studies with over 8000 cases were recruited for pooling proportion of alcohol relapse. The alcohol relapse rate and heavy alcohol relapse rate after LT during the mean follow-up time of 48.4 ± 24.7 months were 22% (95% confidence interval (CI): 19–25%) and 14% (95%CI: 12–16%). Psychiatric comorbidities (odds ratio (OR) 3.46, 95%CI: 1.87–6.39), pre-transplant abstinence of less than 6 months (OR 2.76, 95%CI: 2.10–3.61), unmarried status (OR 1.84, 95%CI: 1.39–2.43), and smoking (OR 1.72, 95%CI: 1.21–2.46) were associated with alcohol relapse after LT. However, we noticed publication bias of unpublished negative studies and high heterogeneity of results. Conclusions Post-transplant alcohol relapse occurred in about one-fifth of patients who underwent alcohol-related LT. Psychiatric comorbidities represented the strongest predictor of alcohol relapse. Psychiatric comorbidities monitoring and pre-LT alcohol abstinence for at least 6 months may decrease alcohol relapse after LT.

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Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Cited by 5 publications

References 52 publications

Management of alcohol recurrence before and after liver transplantation

Management of alcohol recurrence before and after liver transplantation

Alcohol Relapse After Liver Transplantation: Younger Women Are at Greatest Risk

Alcohol relapse and its predictors after liver transplantation for alcoholic liver disease: a systematic review and meta-analysis

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