LIVER-TRANSPLANTATION FOR PATIENTS WITH ALCOHOLISM AND END-STAGE LIVER-DISEASE

Liver transplantation for alcoholic cirrhosis remains controversial. I n particular, criteria for the selection of patients who will remain r ecovered from alcoholism post-transplant require better definition. We analyzed the long-term predictive value of categorizing transplant re ferral patients with alcoholism and end-stage liver disease into risk groups for recidivism and noncompliance. Forty-seven patients with the diagnosis of alcoholism and advanced liver disease were evaluated and placed into predefined risk groups (low-, moderate-, and high-risk) f or recidivism and noncompliance. No absolute period of abstinence from alcohol was required. All patients were asked to sign a contract not to drink alcohol and comply with a rehabilitation program before and a fter transplantation. Compliance with alcohol rehabilitation, abstinen ce, functional level, employment, and survival were assessed. Patients who were not compliant with the rehabilitation program or consumed al cohol were scored as failures. Thirty-one patients were ranked as low risk, and were accepted for liver transplantation; 27 patients were tr ansplanted. Five of 31 patients (16%) drank alcohol. One patient drank before and four patients drank transiently after transplantation. Ten patients were categorized as moderate risk, and were deferred for tra nsplantation; two patients underwent later transplantation. All 10 pat ients (100%) were noncompliant or drank alcohol, including two patient s who drank after transplantation after a period of abstinence and reh abilitation. Six patients were ranked as high risk, and were denied li ver transplantation. Five patients (83%) drank alcohol and were noncom pliant. Minimum follow-up was 12 months (mean, 24 months; range, 12-41 months). The mean Karnofsky performance score was 34 before and 84 af ter liver transplantation. Actuarial survival of alcoholic patients un dergoing transplantation was 93%. We conclude that categorization of t ransplant referral patients with alcoholism and liver failure into pre defined risk groups for recidivism and noncompliance accurately predic ts pre- and post-transplant behavior. As defined, only low-risk alcoho lic patients are good candidates for liver transplantation.