Transplantation for alcoholic liver disease: lessons from the explant?

Bathgate, A.; Hayes, P.
April 2003
Gut;Apr2003, Vol. 52 Issue 4, p462
Academic Journal
Background: End stage alcoholic liver disease (ALD) is a common indication for liver transplantation but alcoholic hepatitis (AH) is often regarded as a contraindication. There is little evidence to support this belief. Objective: To study the effect of superimposed AH on the outcome of liver transplantation for end stage ALD. Design: Case series of consecutive patients undergoing liver transplantation over a five year period at one centre, followed for a median of 30 months. Patients: A total of 169 cases, 68 cases were due to ALD (all abstinent for at least three months). Over half of these (n=36) had histological evidence of AH in the explanted liver. Their outcome was compared with 32 cases without hepatitis and also with the 101 cases undergoing transplant for other reasons, including hepatitis C virus (HCV) infection. Results: Post transplant mortality was similar in all groups (one year survival: 72%, 81%, and 81%; three year survival: 68%, 75%, and 75%; five year survival: 61%, 75%, and 50%, for the ALD cirrhosis, ALD cirrhosis+AH, and HCV cirrhosis groups, respectively). In particular, superimposed AH did not adversely affect outcome. Recidivism occurred in 10% of cases transplanted for ALD but was considered abusive in only two. Conclusion: Survival after liver transplantation was similar in ALD cirrhosis patients with or without AH and cases transplanted for other reasons. Even histologically severe AH did not adversely affect outcome. Points to note: Patients were allegedly abstinent and did not have clinically acute AH, and hence are not representative of the acute cases we see in clinical practice. Therefore, conclusions cannot be drawn on the use of transplantation in these cases.


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