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Excessive alcohol use is a common health care problem worldwide and is associated with significant morbidity and mortality.
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Alcoholic liver disease represents the second most frequent indication for liver transplantation in North America and Europe.
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The pretransplant evaluation of patients with alcoholic liver disease should aim at identifying those at high risk for posttransplant relapse of alcohol use disorder, as return to excessive drinking can be deleterious to graft and patient survival.
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Alcoholic Liver Disease and Liver Transplantation
Section snippets
Key points
Epidemiology of alcohol use and alcoholic liver disease
Chronic excessive alcohol use is a major cause of preventable morbidity and mortality around the world. The World Health Organization (WHO) estimates that approximately 3.3 million deaths worldwide in 2012 were associated with alcohol misuse.1 Not only does chronic alcohol misuse lead to organ damage, it can also lead to increased risk of accidents and violence resulting in morbidity and mortality. The negative effects of alcohol use disproportionately affect the young.
Data from WHO show 9% of
Liver transplantation and alcoholic liver disease
Alcoholic liver disease is a major indication for liver transplantation worldwide. In the United States and Europe, alcoholic liver cirrhosis is the second most common indication for liver transplantation, behind only chronic HCV. Alcoholic liver disease accounts for approximately 40% of primary liver transplants in Europe, and approximately 20% in the United States.16, 17, 18
In a recent analysis of the United Network for Organ Sharing database in the United States from 1987 to 2013, the
Alcoholic liver disease in the pretransplant period
Patients suffering from end-stage alcoholic liver disease who require liver transplantation present a special challenge to the transplant teams, as they have a high prevalence of alcohol-related comorbidities, such as protein-energy malnutrition, chronic anemia, neurologic disorders, kidney dysfunction, heart disease, and psychiatric comorbidities, including substance abuse.19, 20 The risk of relapse of alcohol use disorder following liver transplantation, with potential associated liver
Posttransplant outcomes in alcoholic liver disease
Survival in patients transplanted for alcoholic liver disease is comparable to that of other etiologies, and even better than the long-term survival observed in patients transplanted for HCV.43 In large transplant registries from Europe and the United States, the 1-year, 3-year, and 5-year patient survival ranges from 81% to 92%, 78% to 86%, and 73% to 86%, respectively.16, 17 However, emerging data suggest patients with alcoholic liver disease with posttransplant relapses have a reduced
Liver transplantation in alcoholic hepatitis
AH is a distinct clinical syndrome seen in patients with chronic excessive alcohol use characterized by worsening jaundice, mild to moderate elevation in liver enzymes, coagulopathy, and hepatic encephalopathy. At times it can present as acute-on-chronic liver failure.61, 62
AH has significant morbidity and mortality, as documented both in Europe and the United States.63, 64 In the United States, there were 57,000 hospitalizations for AH in 2007, accounting for 0.7% of all admissions with an
Summary
Excessive chronic alcohol consumption is a common health care problem around the world, with significant morbidity and mortality. End-stage liver disease secondary to alcoholic cirrhosis is the second most frequent cause for liver transplantation in the United States and Europe. Posttransplant outcomes for most patients with alcoholic liver disease are comparable to those of other etiologies; however, patients with alcoholic liver disease have increased graft loss and mortality if they return
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Cited by (15)
Liver Transplantation for Alcoholic Liver Disease: An Update
2019, Clinics in Liver DiseaseCitation Excerpt :All these require monitoring and supplementation.19,21 Indications and contraindications for LT in patients with end-stage ALD are similar to those for other causes; however, there is an additional focus on selecting patients who are less likely to relapse into harmful alcohol use.13 Before referring a patient with end-stage liver disease for transplantation, even if their primary disease is not ALD, a detailed history of the patient’s alcohol and other substance use, and their consequences, is required.
Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States
2017, Clinical Gastroenterology and HepatologyCitation Excerpt :Despite the stringent criteria involved in selecting reformed patients with alcohol-induced liver disease for LT, the number of registrants has increased steadily since 2009, tracking more steeply upward between 2014 and 2015, making it the leading indication for LT registrations among non-HCC registrants, surpassing HCV in 2015. Our data are consistent with a recent report showing that alcohol was a more common indication for LT than nonalcoholic fatty liver disease in 2014.26 When the listing indication of HCC registrants was replaced by the diagnosis of the underlying etiology of liver disease (Figure 1C), alcohol-induced liver disease was still the second leading cause among LT registrants after HCV, but has shown a trajectory of becoming the leading underlying etiology for LT listing, surpassing HCV in the next few years.
Concept and risk factors of alcohol relapse in liver transplant recipients with alcohol-related aetiologies: A scoping review
2023, International Journal of Mental Health NursingLife Expectancy After Liver Transplantation for Alcoholic Cirrhosis
2021, Progress in Transplantation
The authors have nothing to disclose.