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O’Grady’s leading article highlighted the ongoing debate surrounding liver transplantation for alcoholic liver disease (ALD).1 As addiction specialists working in the area of liver transplantation in two other UK centres, we welcome his contribution to the debate, but take this opportunity to develop the argument further and challenge some of his arguments and assumptions.
O’Grady offers us the opportunity to once again consider the issue of liver transplantation for ALD in a more articulate way by providing a useful overview of some of the pros and cons of transplanting this population, as well as carefully highlighting some of the dilemmas. Nevertheless, there are some facets of his report which need further exploration and indeed challenging.
Firstly, we accept that disease recurrence in the first 7–10 years after transplant is negligible when directly compared with the recurrence rates in viral hepatitis C virus (HCV), but it is misleading to prove the efficacy of transplantation for one medical indication by looking at outcomes in another. Historically transplant centres have measured outcome in terms of 5-year graft survival; however, in >40 years of liver transplantation, surgical, medical and drug management regimens have improved considerably and, therefore, it is not unreasonable to expect much greater graft survival in the ALD population. The HCV versus ALD debate is a limited one.
Secondly, we accept that historically too much emphasis has been placed on apparently arbitrary tests to determine candidate selection on ALD, and it would be useful to know which arbitrary tests O’Grady is referring to and how he defines these. In the UK, the liver advisory group (LAG) guidelines on transplantation for ALD2 have at least offered transplant …
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