Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?
Introduction
Alcoholic liver disease (ALD) is the most common cause of cirrhosis in Western countries. In France, mortality related to ALD is 14.3 deaths per 100,000 population [1]. Since the publication by Starzl et al., of the Pittsburgh group [2], showing that the survival of patients with ALD was equal to that of patients with cirrhosis attributable to other causes, increasing numbers of patients with ALD are undergoing liver transplantation (LT). Thus, the prevalence of ALD among adult recipients in the US was 13.2% in 1988 and 26.9% in 1995 [3].
It emerges from most recent studies that when we take into account the usual criteria for success in LT (patient and graft survival, rejection and infections rates), ALD is a good indication for LT [1]. However, the main issue is the likelihood of relapse and its influence on the outcome, because it is the possibility of returning to alcohol use that separates patients with ALD from those with other forms of chronic liver disease. The relapse rates reported in the literature range from 11.5 to 49% [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. The absence of a common nomenclature makes these studies difficult to analyze and compare. Moreover, although alcohol relapse was rarely considered a reason for graft failure among recipients with ALD, graft dysfunction related to relapse ranged from 0 to 17%, and death related to relapse from 0 to 5% [5], [6], [7], [11], [15]. The purpose of this study was to analyze the different patterns of alcohol consumption after LT for ALD, and to assess the consequences of alcohol relapse.
Section snippets
Methods
In this retrospective study, we reviewed all patients transplanted for ALD in our unit since March 1989, and who have survived more than 3 months after transplantation. All patients underwent an extensive and multidisciplinary evaluation, performed by a hepatologist, an anesthetist, and a surgeon, and included a careful cardiac and respiratory work up. A formal psychiatric evaluation was performed since 1995. Before transplantation was considered, abstinence from alcohol consumption was
General population
Of the 128 liver transplant recipients for ALD, 103 were males and 25 were females, with an average age at the time of LT of 49.3±6.8 years. The mean follow-up after LT was 53.8 months (range 5–145). ALD was the only etiologic factor in 73% of patients (93 patients), while the remaining had concomitant hepatitis C (14 patients), hepatitis B (7 patients), hepatocellular carcinoma (12 patients), and hepatitis C and hepatocellular carcinoma (one patient). One-, 5- and 8-year survival rates were
Discussion
Abstinence remains the cornerstone of therapy for alcoholic patients, especially after LT. In the present study, we have found a global incidence of reported alcohol use after LT of 31%, among 127 liver transplant recipients for ALD surviving more than 3 months after LT. However, this study also shows alcohol relapse after LT for ALD is a heterogeneous clinical phenomenon, since among the 40 relapsers, 27 were heavy drinkers and 13 occasional drinkers.
The assessment of alcohol relapse after LT
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