EFFICACY OF LIVER-TRANSPLANTATION FOR ALCOHOLIC CIRRHOSIS WITH RESPECT TO RECIDIVISM AND COMPLIANCE

Many transplant centers are reluctant to accept alcoholic patients for OLT because of their supposed potential for alcoholic recidivism and poor compliance with the required immunosuppressive regimen, both of w hich result in graft failure. Only inconclusive data related to these arguments are available. From May 1982 to January 1993, 58 patients re ceived OLT at our institution for end-stage cirrhosis, where alcohol w as the only toxic component. The indication for OLT in these patients was considered with particular attention to recidivism and compliance. Overall survival in this group was 71% and 63% at 1 and 5 years, resp ectively, with an average survival time of 78 months. Actuarial surviv al of patients transplanted since January 1989 (n=37) was 86% and 83% at 1 and 2 years (average survival 42 months). Nonfatal clinical endpo ints were analyzed in those patients surviving at least 3 months (n=44 ). Return to alcohol abuse has been documented in 14 persons at routin e short-term outpatient checkups. The estimated risk for alcoholic rec idivism amounts to 31%, with a median follow-up of 33 months. Complian ce with immunosuppressive regimen was expressed as a dependent value o f acute rejection episodes (0.3 per patient, median follow-up 33 month s), chronic rejection (occurred in none of the patients), and measurem ents of CsA HPLC blood trough level (92.2% within the target range). T he preversus postoperative improvement of employment, marital, and soc ial status after OLT showed a statistically significant difference. Un willingness to offer OLT to individuals with alcoholic liver disease b ecause of failure to demonstrate 100% long-term abstinence appears dif ficult to defend in the face of good results in survival, compliance, and social rehabilitation.