Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?

Abstract

Background/Aims: The aim of this study was to distinguish the types of alcohol consumption after liver transplantation (LT) for alcoholic cirrhosis and to assess the consequences of heavy drinking.

Methods: Patients transplanted for alcoholic cirrhosis were studied. Alcoholic relapse diagnosis was based upon patient's and family members' reports, liver enzyme tests, graft biopsy, and use of urine alcohol test.

Results: One hundred twenty-eight patients were studied, with a mean follow-up of 53.8 months. After LT, 69% of patients were abstinent, 10% were occasional drinkers, and 21% were heavy drinkers. Actuarial survival rates were not different, but three of the seven deaths observed among heavy drinkers were directly related to alcohol relapse. Although there was no difference between the three groups concerning the rejection rates, all rejection episodes observed in the group of heavy drinkers were related to poor compliance with immunosuppressive drugs. One heavy drinker developed alcoholic cirrhosis.

Conclusions: The present study indicates that patients can resume heavy alcohol consumption after LT for alcoholic liver disease (ALD) and their grafts can be injured because of poor compliance with immunosuppressive drugs and alcohol-related liver injury. Although patient survival was not influenced by alcohol relapse, heavy alcohol consumption can be responsible for patients' death.

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.