LIVER-TRANSPLANTATION FOR ALCOHOLIC LIVER-DISEASE

Orthotopic liver transplantation (OLT) for individuals with alcoholic liver disease (ALD) remains controversial. This review was designed to evaluate the survival, recidivism, and rehabilitation of the alcoholi c liver transplant recipient in a single transplant center. Methods: B etween 10/86 and 11/92 203 liver transplants were performed in 179 pat ients. In 42 patients (23%) the primary etiologic diagnosis was ALD (3 6 males, 6 females, median age 47 yr). All ALD patients were evaluated preoperatively by social service, psychiatry, and medical psychology, in addition to hepatology and transplant surgery. A minimum abstinenc e period of 3-6 months was encouraged, although exceptions were made f or cases of extreme medical urgency in which a good prognosis for abst inence was predicted. Results: In OLT recipients with ALD, actuarial s urvival at 1, 2, and 3 yr was 74%, 71%, and 71%, respectively, compare d to 71%, 71%, and 69% for all OLT recipients. One- and two-year survi val was 85% in the most recently transplanted 86 patients, 20 of whom (23%) had ALD with 1- and 2-yr survival of 84% (N.S.). Recidivism was monitored postoperatively by interviews with the patient and family, s upplemented by random urine and serum toxicology. Of the 29 survivors, 2 (7%) returned temporarily to alcohol use but are presently abstinen t. Although none of the ALD patients in this study was able to work pr ior to OLT, 76% of the survivors at least 4 months post-transplantatio n were employed. Conclusions: Although our experience is small, our re sults suggest that OLT is appropriate therapy for carefully selected p atients with endstage liver failure due to ALD. The multi-disciplinary approach to preoperative evaluation of the alcoholic liver transplant candidate is effective in determining those patients committed to abs tinence after a successful transplant.