Recidivism in Liver Transplant Recipients for Alcohol-related Liver Disease

Abstract

Liver transplantation (LT) is the only cure for patients with end-stage liver disease, which offers good long-term survival. The long-term issues after LT affecting survival are cardiovascular disease, chronic kidney disease, de novo malignancies, recurrence of original disease and immunological causes. Alcoholic-related liver disease (ALD) is one of the most common indications for LT worldwide including India. LT for ALD is associated with several unique challenges as compared with other etiologies. Long-term survival after LT in patients with ALD is affected by recidivism. Various studies have shown different predictors of relapse; the main predictors of relapse are pretransplant abstinence, psychiatric comorbidities, and lack of social support. Although several risk scores have been proposed, these scores are not validated. Studies with active involvement of psychiatrist have shown lower relapse rates. The relapse prevention strategy for reducing likelihood and severity of relapse after initial cessation of alcohol uses a combination of pharmacotherapy and cognitive behavioral approach (identifying and addressing high-risk situations for relapse).

Keywords: ALD, Alcoholic-related liver disease; CI, confidence interval; HRAR, High-Risk Alcoholism Relapse; LT, Liver transplantation; OR, odds ratio; RP, Relapse prevention; SALT, Sustained Alcohol Use PostLT; addiction; cancer; recidivism; smoking; survival.

Figure 1

Management of relapse after liver transplantation.