Alcoholic Liver Disease and Liver Transplantation

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