Download PDF
Semin Liver Dis 2004; 24(3): 249-255
DOI: 10.1055/s-2004-832938
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Transplantation in the Alcoholic Patient

Kymberly D.S Watt1 , Timothy M. McCashland1 , 2
  • 1Departments of Internal Medicine and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska
  • 2Medical Director, Liver Transplantation, University of Nebraska Medical Center, Omaha, Nebraska
Further Information

Publication History

Publication Date:
03 September 2004 (online)

    Permissions and Reprints

Alcoholic liver disease (ALD) is the second leading indication for transplantation in the United States. Most transplant programs in the United States require a minimum of 6 month's abstinence before transplantation is performed. Most studies have shown a recidivism rate of between 20 and 30% by 2 years after orthotopic liver transplantation (OLT). Higher rates of recidivism are reported if pre-OLT abstinence was < 6 months. The impact of recidivism on patient and graft survival is not clear because most reports include patients who consume alcohol in small amounts or infrequently. Equal post-OLT survival for ALD patients and non-ALD patients has been demonstrated, and ALD patients are not thought to suffer greater morbidity post transplant than non-ALD patients. Careful pretransplant assessment for concomitant medical and psychosocial ailments associated with alcoholism is important. Posttransplant monitoring for cardiovascular disease and withdrawal syndromes is required in the early postoperative setting, whereas monitoring for recidivism and malignancy are late postoperative issues.

KEYWORDS

Alcohol - liver disease - and transplantation

REFERENCES

  • 1 Keefe E B. Milestones in liver transplantation for alcoholic liver disease.  Liver Transpl Surg. 1997;  3 197-198
    PubMedGoogle Scholar
  • 2 Starzl T E, Van Thiel D, Tzakis A G et al.. Orthotopic liver transplantation for alcoholic cirrhosis.  JAMA. 1988;  260 2542-2544
    CrossrefPubMedGoogle Scholar
  • 3 Wiesner R H, Lombardero M, Lake J R et al.. Liver transplantation for end-stage alcoholic liver disease: an assessment of outcomes.  Liver Transpl Surg. 1997;  3 231-239
    PubMedGoogle Scholar
  • 4 Keefe E B. Assessment of the alcoholic patient for liver transplantation: comorbidity, outcome and recidivism.  Liver Transpl Surg. 1996;  2 12-20
    PubMedGoogle Scholar
  • 5 Belle S H, Beringer K C, Detre K M. Liver transplantation for alcoholic liver disease in the United States: 1988-1995.  Liver Transpl Surg. 1997;  3 212-219
    PubMedGoogle Scholar
  • 6 Neuberger J, Schulz K H, Day C et al.. Transplantation for alcoholic liver disease.  J Hepatol. 2002;  36 130-137
    PubMedGoogle Scholar
  • 7 Hoofnagle J H, Kresina T, Fuller R K, Lake J R. Liver transplantation for alcoholic liver disease: executive statement and recommendations. Summary of a National Institutes of Health Workshop held December 6-7, 1996 Bethesda, Maryland.  Liver Transpl Surg. 1997;  3 347-350
    CrossrefPubMedGoogle Scholar
  • 8 Kearns P J, Young H, Garcia G et al.. Accelerated improvement of alcoholic liver disease with enteral nutrition.  Gastroenterology. 1992;  102 200-205
    PubMedGoogle Scholar
  • 9 Howard L, Fahy T, Wong P et al.. Psychiatric outcome in alcoholic liver transplant patients.  Q J Med. 1994;  87 731-736
    PubMedGoogle Scholar
  • 10 Gish R G, Lee A, Brooks L et al.. Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation.  Liver Transpl. 2001;  7 581-587
    CrossrefPubMedGoogle Scholar
  • 11 Everhart J E, Beresford T P. Liver transplantation for alcoholic liver disease: a survey of transplantation programs in the United States.  Liver Transpl Surg. 1997;  3 220-226
    CrossrefPubMedGoogle Scholar
  • 12 Keefe E B. Comorbidities of alcoholic liver disease that affect outcome of orthotopic liver transplantation.  Liver Transpl Surg. 1997;  3 251-257
    PubMedGoogle Scholar
  • 13 Lucey M R. Liver transplantation in the alcoholic patient. In: Maddrey WC, Schiff EE, Sorrell MF Transplantation of the Liver. Philadelphia; Lippincott Williams and Wilkins 2001: 319-326
    Google Scholar
  • 14 Kryzhanovski V A, Beller G A. Usefulness of preoperative noninvasive radionuclide testing for detecting coronary artery disease in candidates for liver transplantation.  Am J Cardiol. 1997;  79 986-988
    CrossrefPubMedGoogle Scholar
  • 15 Zoghbi G J, Patel A D, Ershadi R E et al.. Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation.  Am J Cardiol. 2003;  92 1066-1071
    CrossrefPubMedGoogle Scholar
  • 16 Donovan C L, Marcovitz P A, Punch J D et al.. Two-dimensional and dobutamine stress echocardiography in the preoperative assessment of patients with end-stage liver disease prior to orthotopic liver transplantation.  Transplantation. 1996;  61 1180-1188
    PubMedGoogle Scholar
  • 17 Plotkin J S, Benitez R M, Kuo P C et al.. Dobutamine stress echocardiography for preoperative cardiac risk stratification in patients undergoing orthotopic liver transplantation.  Liver Transpl Surg. 1998;  4 252-257
    CrossrefPubMedGoogle Scholar
  • 18 Williams K, Lewis J F, Davis G, Geiser E A. Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation.  Transplantation. 2000;  69 2354-2356
    PubMedGoogle Scholar
  • 19 Keefe B G, Valantine H, Keefe E B. Detection and treatment of coronary artery disease in liver transplant candidates.  Liver Transpl. 2001;  7 755-761
    CrossrefPubMedGoogle Scholar
  • 20 Plotkin J S, Johnson L B, Rustgi V, Kuo P C. Coronary artery disease and liver transplantation: The state of the art.  Liver Transpl. 2000;  6(Suppl 1) S53-S56
    CrossrefPubMedGoogle Scholar
  • 21 Kenngott S, Gerbes A L, Schauer R, Bilzer M. Rapid development of esophageal squamous cell carcinoma after liver transplantation for alcohol-induced cirrhosis.  Transpl Int. 2003;  16 639-641
    CrossrefPubMedGoogle Scholar
  • 22 Duvoux C, Delacroix I, Richardet J P et al.. Increased incidence of oropharyngeal squamous cell carcinomas after liver transplantation for alcoholic cirrhosis.  Transplantation. 1999;  67 418-421
    CrossrefPubMedGoogle Scholar
  • 23 Degos F. Hepatitis C and alcohol.  J Hepatol. 1999;  31(Suppl 1) 113-118
    CrossrefPubMedGoogle Scholar
  • 24 Schiff E R. The alcoholic patient with hepatitis C virus infection.  Am J Med. 1999;  27 95S-99S
    PubMedGoogle Scholar
  • 25 Wiley T E, McCarthy M, Breidi L et al.. Impact of alcohol on the histological and clinical progression of hepatitis C infection.  Hepatology. 1998;  28 805-809
    CrossrefPubMedGoogle Scholar
  • 26 Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C.  Lancet. 1997;  349 825-832
    CrossrefPubMedGoogle Scholar
  • 27 Pessione F, Degos F, Marcellin P et al.. Effect of alcohol consumption on serum hepatitis C virus RNA and histologic lesions in chronic hepatitis C.  Hepatology. 1998;  27 1717-1722
    CrossrefPubMedGoogle Scholar
  • 28 Corrao G, Aricos S. Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis.  Hepatology. 1998;  27 914-919
    CrossrefPubMedGoogle Scholar
  • 29 Ostapowicz G, Watson K JR, Locarnini S A, Desmond P V. Role of alcohol in the progression of liver disease caused by hepatitis C virus infection.  Hepatology. 1998;  27 1730-1735
    CrossrefPubMedGoogle Scholar
  • 30 Anderson S, Nevins C L, Green L K et al.. Assessment of liver histology in chronic alcoholics with and without hepatits C virus infection.  Dig Dis Sci. 2001;  46 1393-1398
    CrossrefPubMedGoogle Scholar
  • 31 Yamanaka T, Shiraki K, Nakazaawa S et al.. Impact of hepatitis B and C virus infection on the clinical prognosis of alcoholic liver cirrhosis.  Anticancer Res. 2001;  21 2937-2940
    PubMedGoogle Scholar
  • 32 Yamauchi M, Nakahara M, Maezawa Y et al.. Prevalence of hepatocellular carcinoma in patients with alcoholic cirrhosis and prior exposure to hepatitis C.  Am J Gastroenterol. 1993;  88 39-43
    PubMedGoogle Scholar
  • 33 Donato F, Tagger A, Chiesa R et al.. Hepatitis B and C virus infection, alcohol drinking and hepatocellular carcinoma: a case control study in Italy.  Hepatology. 1997;  26 579-584
    CrossrefPubMedGoogle Scholar
  • 34 Mackie J, Groves K, Hoyle A et al.. Orthotopic liver transplantation for alcoholic liver disease: a retrospective analysis of survival, recidivism and risk factors predisposing to recidivism.  Liver Transpl. 2001;  7 418-427
    CrossrefPubMedGoogle Scholar
  • 35 Platz K P, Mueller A R, Spree E et al.. Liver transplantation for alcoholic cirrhosis.  Transpl Int. 2000;  13(Suppl 1) S127-S130
    CrossrefPubMedGoogle Scholar
  • 36 Veldt B J, Laine F, Guillygomarc'h A et al.. Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing.  J Hepatol. 2002;  36 93-98
    PubMedGoogle Scholar
  • 37 Pageaux G P, Michel J, Coste V et al.. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism.  Gut. 1999;  45 421-426
    PubMedGoogle Scholar
  • 38 Bravata D M, Olkin I, Barnato A E et al.. Employment and alcohol use after liver transplantation for alcoholic and nonalcoholic liver disease: a systematic review.  Liver Transpl. 2001;  7 191-203
    CrossrefPubMedGoogle Scholar
  • 39 Vaillant G E. The natural history of alcoholism and its relationship to liver transplantation.  Liver Transpl Surg. 1997;  3 304-310
    PubMedGoogle Scholar
  • 40 Yates W R, Martin M, LaBrecque D et al.. A model to examine the validity of the 6-month abstinence criterion for liver transplantation.  Alcohol Clin Exp Res. 1998;  22 513-517
    PubMedGoogle Scholar
  • 41 Tome S, Lucey M R. Timing of liver transplantation in alcoholic cirrhosis.  J Hepatol. 2003;  39 302-307
    CrossrefPubMedGoogle Scholar
  • 42 Poynard T, Naveau S, Doffoel M et al.. Evaluation of efficacy of liver transplantation in alcoholic cirrhosis using matched and simulated controls: 5-year survival. Multi-Centre Group.  J Hepatol. 1999;  30 1130-1137
    CrossrefPubMedGoogle Scholar
  • 43 Everson G T, Bharadhwaj G, House R et al.. Long-term follow-up of patients with alcoholic liver disease who underwent hepatic transplantation.  Liver Transpl Surg. 1997;  3 263-274
    PubMedGoogle Scholar
  • 44 Farges O, Saliba F, Farmahant H et al.. Incidence of rejection and infection after liver transplantation as a function of the primary disease: possible influence of alcohol and polyclonal immunoglobulins.  Hepatology. 1996;  23 240-248
    PubMedGoogle Scholar
  • 45 Pageaux G P, Bismuth M, Perney P et al.. Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?.  J Hepatol. 2003;  38 629-634
    CrossrefPubMedGoogle Scholar
  • 46 Burra P, Mioni D, Cecchetto A et al.. Histological features after liver transplantation in alcoholic cirrhotics.  J Hepatol. 2001;  34 716-722
    CrossrefPubMedGoogle Scholar
  • 47 Savolainen V, Perola M, Lalu K et al.. Early perivenular fibrogenesis - precirrhotic lesions among moderate alcohol consumers and chronic alcoholics.  J Hepatol. 1995;  23 524-531
    CrossrefPubMedGoogle Scholar
  • 48 Conjeevaram H S, Hart J, Lissoos T W et al.. Rapidly progressive liver injury and fatal alcoholic hepatitis occurring after liver transplantation in alcoholic patients.  Transplantation. 1999;  67 1562-1568
    CrossrefPubMedGoogle Scholar
  • 49 McCurry K R, Baliga P, Merion R M et al.. Resource utilization and outcome of liver transplantation for alcoholic cirrhosis. A case-control study.  Arch Surg. 1992;  127 772-777
    PubMedGoogle Scholar
  • 50 Gerhardt T C, Goldstein R M, Urschel H C et al.. Alcohol use following liver transplantation for alcoholic cirrhosis.  Transplantation. 1996;  62 1060-1063
    CrossrefPubMedGoogle Scholar
  • 51 Fabrega E, Crespo J, Casafont F et al.. Alcoholic recidivism after liver transplantation for alcoholic cirrhosis.  J Clin Gastroenterol. 1998;  26 204-206
    CrossrefPubMedGoogle Scholar
  • 52 Osorio R W, Ascher N L, Avery M et al.. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease.  Hepatology. 1994;  20 105-110
    CrossrefPubMedGoogle Scholar
  • 53 Tang H, Boulton R, Gunson B et al.. Patterns of alcohol consumption after liver transplantation.  Gut. 1998;  43 140-145
    PubMedGoogle Scholar
  • 54 Shakil A O, Pinna A, Demetris J et al.. Survival and quality of life after liver transplantation for acute alcoholic hepatitis.  Liver Transpl Surg. 1997;  3 240-244
    PubMedGoogle Scholar
  • 55 Tome S, Martinez-Rey C, Gonzalez-Quintela A et al.. Influence of superimposed alcoholic hepatitis on the outcome of liver transplantation for end-stage alcoholic liver disease.  J Hepatol. 2002;  36 793-798
    CrossrefPubMedGoogle Scholar
  • 56 Bonet H, Manez R, Kramer D et al.. Liver transplantation for alcoholic liver disease: survival of patients transplanted with alcoholic hepatitis plus cirrhosis as compared with those with cirrhosis alone.  Alcohol Clin Exp Res. 1993;  17 1102-1106
    PubMedGoogle Scholar
  • 57 Lucey M R. Is liver transplantation an appropriate treatment for acute alcoholic hepatitis?.  J Hepatol. 2002;  36 829-831
    CrossrefPubMedGoogle Scholar

Timothy M McCashlandM.D. 

983285 Nebraska Medical Center

Omaha, NE 68198-3285

Email: tmccash@unmc.edu