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

Kawaguchi, Yoshikuni; Sugawara, Yasuhiko; Yamashiki, Noriyo; Kaneko, Junichi; Tamura, Sumihito; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Nojiri, Kayo; Kokudo, Norihiro

doi:10.1111/hepr.12065

Cited by 18 publications

(14 citation statements)

References 26 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: 83%

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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: 83%

“…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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“…A patient with ALC may return to a pattern of alcohol consumption, which potentially can damage the transplanted liver and affect compliance with the immunosuppressive regimen and follow‐up appointments; this may put the graft at risk . Hence, selection criteria for predicting alcohol relapse from preoperative data and postoperative education and support to keep patients away from recidivism have been strengthened …”

mentioning

confidence: 99%

“…In 1990, Bird et al reported the usefulness of an abstinence period of at least 6 months. Since then, the 6‐month rule has been the most widely used criterion . However, the length of abstinence before transplantation has not predicted alcohol relapse in some studies .…”

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confidence: 99%

Risk factors for alcohol relapse after liver transplantation for alcoholic cirrhosis in Japan

et al. 2014

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Alcoholic liver cirrhosis (ALC) is an established indication for liver transplantation (LT). Most LT procedures in Japan are living donor liver transplantation (LDLT) because of an extreme shortage of deceased donors. Social circumstances enabling LDLT could be favorable for preventing relapse. The aims of this retrospective study were to analyze the outcomes of LDLT for ALC and to evaluate risk factors for relapse in this cohort. One hundred ninety-five subjects underwent LT [LDLT (n 5 187), deceased donor LT (n 5 5), or domino LT (n 5 3)] for ALC in Japan from November 1997 to December 2011. Risk factors for alcohol relapse and the impact of relapse on outcomes were analyzed for 140 patients after the exclusion of 26 patients who died in the hospital and 29 patients without information about alcohol relapse. The incidence of alcohol consumption after LT was 22.9%. The risk factors for patient survival were a donor age 50 years (P < 0.01) and a Model for End-Stage Liver Disease score 19 (P 5 0.03). The 10-year patient survival rates were 21.9% and 73.8% for patients who had relapsed and patients who had not relapsed 18 months after LT, respectively (P 5 0.01). The relapse rates were 50.0%, 34.5%, 13.3%, 19.7%, and 14.3% for patients who had received livers from parents, siblings, spouses, sons/daughters, and deceased or domino donors, respectively. A history of treatment for psychological diseases other than alcoholism before LT was a significant indicator for the risk of recidivism (P 5 0.02), and noncompliance with clinic visits after LT and smoking after transplantation were promising indicators for the risk of recidivism (P 5 0.06, and P 5 0.05, respectively). Preoperative alcohol consumption was not a risk factor. In conclusion, rather than selecting patients on the basis of preoperative alcohol use, we should provide sociomedical support to improve adherence after LT for ALC in Japan. Liver Transpl 20:298-310, 2014. V C 2013 AASLD.

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“…This study followed a 6-month abstinence rule and participation in a rehabilitation program, psychiatric consultation, and written agreement declaring an intention of lifetime abstinence. 36 We found relapse rate of 10.7% in 270 LDLT patients (published in abstract form). 37 The lower relapse rate in our series could be secondary to LDLT, active psychiatrist involvement, close follow-up of patients after liver transplantation, and role of strong Indian family support.…”

Section: Living Donor Liver Transplantation and Alcoholic Liver Diseasementioning

confidence: 77%

Liver Transplantation for Alcohol-Related Liver Disease

Choudhary

Kumar

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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Alcoholic liver disease (ALD) is a common indication for liver transplantation. It is a much debated indication for deceased donor liver transplantation due to organ shortage and potential of alcohol relapse after liver transplantation. A six-month abstinence before liver transplantation is required at most centers to decrease chances of alcohol relapse after liver transplantation. However, this rule is not relevant for patients with severe alcoholic hepatitis or severely decompensated patients who are unlikely to survive till 6 months. Long-term care of these patients after liver transplantation includes assessment of relapse, smoking, and surveillance of de novo malignancies. Current review discusses role of abstinence, factors affecting alcohol relapse, liver transplantation for alcoholic hepatitis, role of living donor liver transplantation, and long-term care of ALD patients who undergo liver transplantation. ( J CLIN EXP HEPATOL 2016;6:47-53) A lcoholic liver disease (ALD) is common indication for liver transplantation worldwide, 1,2 and is a common cause of decompensated cirrhosis and acute-on-chronic liver failure in India as well. 3,4 ALD has good outcome after liver transplantation that is comparable or better than other etiologies of liver transplantation. Recent European liver transplant registry data showed 73% 5-year and a 59% 10-year survival rate for ALD. 2 However, survival is lower in recipients who relapse to harmful pattern of drinking as noted in a systemic review of 13 studies by Rustad et al. 5 Liver transplantation for ALD leads to improvement in quality of life and employment rates. 6,7 During selection of these patients for liver transplantation, it is important to identify other alcohol-related problems like cardiomyopathy, chronic pancreatitis, skeletal muscle wasting, and neurotoxicities that may preclude or impair outcome of liver transplantation. 8 Patients who have lack of social support, are active smokers, and have psychiatric disorders or alcohol dependence should be listed only with reservations. 9 Smoking worsens the outcome of alcohol-related liver disease 10 and active smoking at the time of liver transplantation has been shown to be associated with post-transplant recidivism also. 11 PREDICTORS OF RELAPSEWhile liver transplantation improves functions of liver and cures complications of portal hypertension, it does not affect alcoholism and recipients may relapse again, sometimes to harmful levels of drinking, and pretransplant sobriety does not confirm sobriety after liver transplant. [12][13][14] Relapse may be in the form of occasional slips or harmful drinking pattern for a prolonged period; the later affects graft and patient survival. 5,11 Initially, 6-month abstinence was considered as a requirement before allocating organ to patients with ALD; however, it was based on poor quality small data. 15 The 6-month rule serves 2 purposes; it provides patient time to demonstrate a certain period of abstinence and patient may recover on medical management, and thus preempt...

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

Abstract: Living donor LT for patients with ALD who complied with the 6-month abstinence rule provides sufficient survival benefit with good compliance, compensating for the potential risks to the donors.

Cited by 18 publications

References 26 publications

Management of alcohol recurrence before and after liver transplantation

Management of alcohol recurrence before and after liver transplantation

Risk factors for alcohol relapse after liver transplantation for alcoholic cirrhosis in Japan

Liver Transplantation for Alcohol-Related Liver Disease

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