Successful Post-Transplant Psychiatric Interventions During Long-Term Follow-Up of Patients Receiving Liver Transplants for Alcoholic Liver Disease

Abstract

Case seriesPatient: Male, 44 • Male, 44 • Female, 36Final Diagnosis: Alcohol use disorders in sustained remissionSymptoms: Relapse of alcohol use • stress-related anger/irritation • zolpidem abuseMedication: —Clinical Procedure: Psychiatric interventionSpecialty: TransplantologyObjective:Unusual setting of medical careBackground:Around 20–30% of patients who undergo liver transplantation (LT) for alcoholic liver disease (ALD) will resume heavy drinking after LT. It is crucial to control post-transplant relapse of alcohol use, because alcoholic recidivism has been shown to have a negative impact on post-transplant compliance and long-term outcomes of LT recipients. However, there is currently no specific, effective psychiatric intervention for preventing additional alcohol consumption in clinical practice.Case Report:We present 3 patients who underwent LT for ALD at Nagoya University Hospital who were followed up for prolonged periods (7.2, 8.8, and 11.3 years, respectively), and review the psychiatric interventions employed to address critical situations. Additional alcohol consumption was noted in Case 1, but prompt collaborative care led to stable abstinence. In Case 2, marked anger and irritation were exacerbated as a result of work, but the anger was controlled by anger management. Case 3 abused a minor tranquilizer, but limit-setting resulted in adequate medical adherence.Conclusions:Transplant teams need to provide comprehensive treatment for alcoholic recidivism to improve long-term health after LT for ALD.

Concept and risk factors of alcohol relapse in liver transplant recipients with alcohol‐related aetiologies: A scoping review

“…There were no studies that explored psychosocial consequences of alcohol consumption after LT. Eight studies presented the effects of substance abuse treatment, alcohol contracts and multidisciplinary addiction teams in the prevention or identification of alcohol relapse (Attilia et al, 2018; Choudhary et al, 2022; Donnadieu‐Rigole et al, 2019; Kimura et al, 2017; Lee et al, 2018; Magistri et al, 2019; Masson et al, 2014; Rodrigue et al, 2013). Two of these studies were prospective and random selection was not performed.…”

Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation

“…Patients should receive assistance to access services that can improve posttransplant adherence (including addictions treatment and counseling). 76 , 77 Also, given the potential risk of relapse after the transplantation, it is important that patients have access to addiction services to reduce this risk. However, not all Canadian transplant programs currently have the resources and expertise to support and assess patients with cannabis and alcohol use disorder.…”