Predictors of Relapse to Significant Alcohol Drinking After Liver Transplantation

Karim, Zamil; Intaraprasong, Pongphob; Scudamore, Charles H.; Erb, Siegfried R.; Soós, J; Cheung, Elsie; Cooper, Polly; Buzckowski, Andrzej; Chung, Stephen W.; Steinbrecher, Urs P.; Yoshida, Eric M.

doi:10.14309/00000434-200910003-00316

Cited by 13 publications

(18 citation statements)

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“…38 However, even for alcoholism, there are conflicting data about whether these policies are predictive of posttransplant recidivism. [39][40][41][42][43][44][45] Similar to alcoholism, all of the controversial characteristics studied in our survey have the potential to progress, recur, or cause medical or psychosocial issues before and after transplantation.…”

Section: Discussionmentioning

confidence: 95%

National survey of provider opinions on controversial characteristics of liver transplant candidates

et al. 2013

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Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age 80 years (62.7%), a body mass index 45 kg/m 2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria.

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Section: Discussionmentioning

confidence: 95%

National survey of provider opinions on controversial characteristics of liver transplant candidates

et al. 2013

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“…Table 4 shows the characteristics of 13 patients with decompensated liver cirrhosis due to ALD who underwent LDLT. The median Child-Pugh score was 11 (range, 7-12) and MELD score was 19 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Alcoholic liver cirrhosis in three patients (cases 2, 9 and 11) was caused by a relatively small amount of lifetime alcohol consumption (0.59 ton, 0.34 ton and 0.58 ton).…”

Section: T He Flow Of Study Participants Is Shown Inmentioning

confidence: 99%

Role of 6‐month abstinence rule in living donor liver transplantation for patients with alcoholic liver disease

Kawaguchi

Sugawara

Yamashiki

et al. 2013

Hepatology Research

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“…Twenty to thirty percent of orthotopic liver transplants are performed for patients with endstage ALD, 2 and alcohol use disorders are the first or second leading cause of liver transplantation. 3,4 Among the reasons for monitoring and encouraging abstinence in ALD patients are the stabilization of their medical condition before surgery and the improvement of their prospects for long-term sobriety afterward. 3 Unfortunately, the recurrence of drinking is common even in ALD patients who have committed to abstinence and who have already been selected for liver transplantation.…”

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confidence: 99%

“…3,4 Among the reasons for monitoring and encouraging abstinence in ALD patients are the stabilization of their medical condition before surgery and the improvement of their prospects for long-term sobriety afterward. 3 Unfortunately, the recurrence of drinking is common even in ALD patients who have committed to abstinence and who have already been selected for liver transplantation. 2,5,6 It has also been argued that with consistent abstinence, a candidate for ALDrelated transplantation might in fact no longer require a graft.…”

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confidence: 99%

Assessing the drinking status of liver transplant patients with alcoholic liver disease

et al. 2013

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The accurate assessment of drinking by patients with alcoholic liver disease is important both before and after liver transplantation. Unfortunately, self-reports by these individuals often underestimate their actual alcohol consumption. Several recently developed biochemical measures can provide additional information on a patient's use of alcohol. This article describes ethyl glucuronide, ethyl sulfate, phosphatidyl ethanol, and carbohydrate-deficient transferrin as biomarkers of drinking and summarizes research dealing with their application in patients with alcohol use disorders who are candidates for or recipients of liver transplantation. The article also offers suggestions for enhancing the reliability of self-report measures of drinking status.

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Predictors of Relapse to Significant Alcohol Drinking After Liver Transplantation

Cited by 13 publications

References 0 publications

National survey of provider opinions on controversial characteristics of liver transplant candidates

National survey of provider opinions on controversial characteristics of liver transplant candidates

Role of 6‐month abstinence rule in living donor liver transplantation for patients with alcoholic liver disease

Assessing the drinking status of liver transplant patients with alcoholic liver disease

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