Elsevier

Transplantation Proceedings

Volume 38, Issue 9, November 2006, Pages 2937-2940
Transplantation Proceedings

Liver transplantation
Candidate
Efficacy of 6-Month Pretransplant Abstinence for Patients With Alcoholic Liver Disease Undergoing Living Donor Liver Transplantation

https://doi.org/10.1016/j.transproceed.2006.08.139Get rights and content

Abstract

Purpose

Questions have been raised regarding the ethics of liver transplantation in patients with alcoholic liver disease (ALD), including the fairness of cadaveric organ allocation to individuals who abuse alcohol and the efficacy of transplantation in these patients, many of whom may relapse. Living donor liver transplantation (LDLT) for ALD patients raises the similar ethical issues. ALD candidates for cadaveric liver transplants are required to abstain from alcohol for 6 months before being listed, but the efficacy of 6 months of abstinence in ALD patients receiving LDLT is not known.

Methods

We therefore determined the efficacy of 6 months of pretransplant abstinence in 15 ALD patients who underwent LDLT from February 1997 to December 2003.

Results

The Model for End-stage Liver Disease score was 24 ± 10, and mean pretransplant abstinence period was 15 ± 13 months, with 11 (73.3%) patients being abstinent for at least 6 months. Four patients received dual grafts, making the number of living donors 19: 12 children, two wives, one brother, three nephews, and one aunt. There were no unrelated donors. Three patients showed a relapse to alcohol drinking. The overall 1-, 3-, and 5-year survival rates were 100%, 100%, and 87.5%, respectively, and the cumulative 1-, 3-, and 5-year relapse rates were 6.7%, 20%, and 20%, respectively. The relapse rates in patients who did and did not maintain 6 months of abstinence were 9.1% and 50%, respectively; this difference was not significant (P = .154), likely due to the small sample size. Younger recipient age was a significant risk factor for alcohol relapse (40 ± 8 years versus 53 ± 6 years; P = .004).

Conclusions

Pretransplant abstinence of 6 months seemed to be beneficial. For ethical reasons, a 6-month abstinence rule should be strictly observed in LDLT.

Section snippets

Materials and methods

From February 1997 to December 2003, 580 adult-to-adult LDLTs were performed in our institution.12 Of these, 20 recipients were diagnosed with ALD, but five were excluded due to concurrent association with viral hepatitis or other diseases. All 15 patients were confirmed as having ALD, by both a history of chronic alcohol intake and a profile of biochemical parameters. Alcoholic cirrhosis was later confirmed by histological examination of the explanted liver.

Criteria for liver transplantation

Patient and Donor Profiles

The demographic profiles of the 15 patients are summarized in Table 1. Twelve patients (80%) manifested complications associated with portal hypertension. All patients underwent LDLT within 3 months of enrollment. Of the 15 patients, 4 (26.7%) did not meet the 6-month abstinence rule, but none of these underwent transplantation in an urgent or emergency situation. Eleven patients (73.3%) received single grafts, and 4 (26.7%) received dual grafts. All donors were related to the recipients; there

Discussion

ALD is a leading cause of end-stage liver disease in Western countries, resulting in 7.9 deaths per 100,000 individuals in the United States.13 The mortality rates of advanced alcoholic cirrhosis are extremely high, with 1- and 5-year mortality rates of 49% and 71%, respectively.14 As a result, alcoholic cirrhosis is one of the most common causes of liver transplantation in Western countries. Although little is known about the optimal timing of liver transplantation in ALD patients, prognostic

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