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. 2013 Sep;37(9):1601-8.
doi: 10.1111/acer.12117. Epub 2013 Apr 11.

Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center

Giovanni Addolorato  1 , Antonio Mirijello, Lorenzo Leggio, Anna Ferrulli, Cristina D'Angelo, Gabriele Vassallo, Anthony Cossari, Giovanni Gasbarrini, Raffaele Landolfi, Salvatore Agnes, Antonio Gasbarrini; Gemelli OLT Group
Collaborators, Affiliations

Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center

Giovanni Addolorato et al. Alcohol Clin Exp Res. 2013 Sep.

Abstract

Background: Many concerns about liver transplantation in alcoholic patients are related to the risk of alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit (AAU) was formed within the liver transplant center for the management of alcoholic patients affected by end-stage liver disease and included in the waiting list for transplantation. We evaluated retrospectively the impact of the AAU on alcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration of alcohol abstinence before transplant was evaluated as well.

Methods: Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation. Clinical evaluation and management of alcohol use in these patients was provided by psychiatrists with expertise in addiction medicine not affiliated to the liver transplant center before 2002 (n = 37; group A), or by the clinical staff of the AAU within the liver transplant center starting from 2002 (n = 55; group B).

Results: Group B, as compared with group A, showed a significantly lower prevalence of alcohol recidivism (16.4 vs. 35.1%; p = 0.038) and a significantly lower mortality (14.5 vs. 37.8%; p = 0.01). Furthermore, an analysis of group B patients with either ≥6 or <6 months of alcohol abstinence before transplantation showed no difference in the rate of alcohol recidivism (21.1 vs. 15.4%; p = ns).

Conclusions: The presence of an AAU within a liver transplant center reduces the risk of alcohol recidivism after transplantation. A pretransplant abstinence period <6 months might be considered, at least in selected patients managed by an AAU.

Keywords: Alcohol Addiction Unit; Alcohol Dependence; Alcohol Recidivism; Alcoholism; Orthotopic Liver Transplantation.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1
Number of patients, divided by etiologies, who underwent liver transplantation between 1995 and 2009. Trend of transplantation for alcoholic cirrhosis.
Figure 2
Figure 2
Percentage of patients who showed recidivism after liver transplantation, and statistical comparison (p=0.005). (AAU= Alcohol Addiction Unit).
Figure 3
Figure 3
Kaplan–Meier survival analysis of the two groups of patients, followed and not followed at the Alcohol Addiction Unit. Figure 3a: Results from Kaplan-Meier analysis. Estimated survival probability curves for patients followed and not followed at the Alcohol Addiction Unit, together with p-values from log-rank tests at different times of observation. (AAU: Alcohol Addiction Unit; OLT: Orthotopic Liver Transplantation). Figure 3b: Difference in the estimated survival probability for patients followed and not followed at the Alcohol Addiction Unit, along with the related confidence bands. (OLT: Orthotopic Liver Transplantation).
Figure 4
Figure 4
Percentage of patients, followed at the Alcohol Addiction Unit, who showed recidivism, lapse, relapse and mortality after liver transplantation, grouped on the basis of the pre-transplant length of alcohol abstinence (>/< 6 months). (p=ns).
See this image and copyright information in PMC

Comment in

  • Liver transplantation in alcoholic patients--reply.
    Mirijello A, Vassallo G, Addolorato G. Mirijello A, et al. Alcohol Clin Exp Res. 2014 Jun;38(6):1799. doi: 10.1111/acer.12241. Epub 2013 Aug 16. Alcohol Clin Exp Res. 2014. PMID: 23952179 No abstract available.
  • Liver transplantation in alcoholic patients.
    Testino G, Leone S, Sumberaz A, Borro P. Testino G, et al. Alcohol Clin Exp Res. 2014 Jun;38(6):1800-2. doi: 10.1111/acer.12242. Epub 2013 Aug 19. Alcohol Clin Exp Res. 2014. PMID: 24033401 No abstract available.

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