A team from Scotland and the USA examined all aspects of liver transplantation associated with alcohol abuse.
They conducted a retrospective cohort analysis of 123 alcoholic patients, with a median of 7 years follow-up at one center.
In addition to alcohol, 35% of the patients had another possible factor contributing to cirrhosis.
Actuarial patient and graft survival rates were, respectively, 84% and 81% (1 year); 72% and 66% (5 years); and 63% and 59% (7 years).
After transplantation, 15% of subjects manifested 21 noncutaneous de novo malignancies. This was significantly more than controls. Upper aerodigestive squamous carcinomas were over-represented.
|Patient and graft survival rates:|
1 year: 84% and 81%
5 years: 72% and 66%
7 years: 63% and 59%
The researchers found that 13 patients had definitely relapsed and 3 others were suspected to have relapsed. Relapse was predicted by daily ethanol consumption, but not by duration of pretransplant sobriety or explant histology.
No patient was found to have alcoholic hepatitis after transplantation. Neither late onset acute nor chronic rejection was significantly increased.
The team also conducted multiple regression analyses for predictors of graft failure. They identified major biliary/vascular complications, chronic bile duct injury on biopsy, and pericellular fibrosis on biopsy as predictors. Graft viral hepatitis was marginally significant on univariate analysis.
Christopher O.C. Bellamy of Edinburgh University Medical School, Scotland, said on behalf of the group, "Alcoholic liver disease is an excellent indication for liver transplantation in those without coexistent conditions.
"Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure.
"Potential recipients should be heavily screened before transplantation, for coexistent conditions such as hepatitis C and metabolic diseases. Other target-organ damage should also be assessed, especially aerodigestive malignancy. These are greater causes of morbidity and mortality than is recurrent alcohol liver disease," he concluded.