PATTERNS OF ALCOHOL-CONSUMPTION AFTER LIVER-TRANSPLANTATION

Background-Uncertainty exists about the extent and consequences of a r eturn to alcohol consumption after liver transplantation for alcoholic liver disease (ALD). Aims-To determine the prevalence and consequence s of alcohol consumption in patients transplanted for ALD. Methods-A r etrospective case controlled study of all patients transplanted for AL D at the Queen Elizabeth Hospital, Birmingham, between 1987 and 1996. Results-Seventy patients with ALD were transplanted, of which 59 survi ved more than three months; 56 were interviewed. Twenty eight had cons umed some alcohol after transplantation; for the nine ''heavy drinkers '' (HD), the median time to resumption of alcohol intake was six month s and for the 19 ''moderate drinkers'' (h-ID) it was eight months. The re was no significant difference in episodes of acute rejection or com pliance with medication between those who were abstinent, MD, or HD. H istological evidence of liver injury was common in ALD patients who ha d returned to drink. Mild fatty change was found in 1/11 biopsy specim ens from abstinent patients but moderate to severe fatty change and ba llooned hepatocytes were seen in 3/5 MD and 2/5 HD specimens. Two HD p atients had early fibrosis. One HD patient has died of alcohol related complications. Conclusions-Moderate to heavy alcohol consumption occu rs in patients transplanted for ALD. Patient recall of abstinence advi ce is unreliable, and patients return to alcohol mainly within the fir st year after liver transplantation. Return to alcohol consumption aft er liver transplantation is associated with rapid development of histo logical liver injury including fibrosis.