LIVER-TRANSPLANTATION FOR ALCOHOLIC CIRRH OSIS - SELECTIVE INDICATIONS

Alcoholic liver disease represents about 15% of all indications for li ver transplantation. Patient selection is difficult, and must be rigor ous. Peri operative risks are evaluated on the same basis as for other chronic liver diseases, with special attention for alcoholic extra-he patic morbidity and nutritional status. Definite withdrawal from alcoh ol is mandatory. Predictive factors of longterm abstinence are the abs ence of psychopathologic state, an adequate social and affective situa tion, the possibilities of professional reinsertion, and a strong moti vation of the patient towards liver transplantation. A six-month perio d of complete abstinence before registration on a liver transplantatio n waiting list is not mandatory, although intermittent alcoholic abuse before transplantation should be an exclusion factor. Liver transplan tation must be proposed based on the severity of liver failure, as ass essed by pronostic stores. It must be rapidly discussed following an a cute episode of decompensation, in the absence of a significant improv ement despite adequate medical therapy, It must also be discussed for long term abstinent patients, with an apparently stabilized cirrhosis, but with an important decrease of the functional liver mass. The eval uation of the functional liver mass is based upon the Child-Pugh score , associated with the results of metabolic liver function tests, the m easurement of the hepatic volume and the severity of portal hypertensi on.