Background and Methods
“Alcoholic liver disease” is a leading indication for hepatic transplantation, but a controversial use of resources. We aimed to examine the long term morbidity and mortality after liver transplantation for alcohol abuse, and undertook a retrospective cohort analysis of 123 alcoholic patients with a median of 7 years follow-up at one center.
Results
In addition to alcohol, 43 (35%) patients had another possible factor contributing to cirrhosis. Actuarial patient and graft survival rates were, respectively, 84% and 81% (1 year) and 63% and 59% (7 years). Eighteen patients (15%) manifested 21 internal malignancies, (p= 0.0001 vs. controls), amongst which upper aerodigestive squamous carcinomas were over-represented (p=0.03). Independent predictors of graft failure were major biliary/vascular complications (p=0.01), chronic bile duct injury on biopsy (p=0.002), and pericellular fibrosis on biopsy (p=0.05); graft viral hepatitis was marginally significant (p=0.07) on univariate analysis. Drinking relapse affected 13 patients, and was suspected for 3 others. Relapse was predicted by pretransplant daily ethanol consumption (p=0.0314), but not by duration of pretransplant sobriety or explant histology. No patient had alcoholic hepatitis after transplantation, and neither late onset acute nor chronic rejection was significantly increased compared with controls.
Conclusions
Alcohol liver disease is an excellent indication for liver transplantation in those without co-existent conditions. Recurrent alcoholic liver disease is not a major cause of graft disease or failure. However, potential allograft recipients should be heavily screened for co-existent conditions (e.g. HCV, metabolic diseases) and other target organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than recurrent alcohol liver disease.