Rapidly progressive liver injury and fatal alcoholic hepatitis occurring after liver transplantation in alcoholic patients

Alcohol-related liver disease (ALD) is a common indication for orthotopic l iver transplantation (OLT) in adults. Although return to 'heavy drinking' p ost-OLT is believed to be uncommon, the prevalence and severity of alcohol- related liver injury in such patients is not well characterized. We retrosp ectively reviewed the records of 68 adult patients who underwent OLT for AL D to determine the incidence of return to heavy drinking and to assess thei r clinical outcome. Follow-up ranged from 8-99 months (mean 42) post-OLT; 5 4 patients were followed for greater than or equal to 12 months, Ten patien ts (15%) had evidence of coexisting viral hepatitis (hepatitis C in 9 and h epatitis B in 1) before OLT. Six of 68 patients (8%) returned to heavy drin king post-OLT, and three of those died of alcoholic hepatitis at nine month s, 2.5 and 3.5 years after OLT. In two of these three patients, premortem l iver biopsy showed histologic features of alcoholic hepatitis in addition t o bridging fibrosis or cirrhosis. None of the three patients who died of AL D had coexisting viral hepatitis. Of the 57 patients surviving for greater than or equal to 3 months post-OLT, 4 of 8 patients (50%) with steatosis an d Mallory bodies in their native livers returned to heavy drinking compared to only 2/49 (4%) without these histologic findings (P<0.05). In conclusio n, the incidence of heavy drinking post-OLT was uncommon, however, it was a ssociated with fatal alcoholic hepatitis in 50% of patients. Rapidly progre ssive alcohol-related liver injury was seen even in the absence of coexisti ng viral hepatitis. The presence of steatosis and Mallory bodies in the nat ive liver, which suggests recent or ongoing alcohol-related liver injury, p redicted a return to heavy drinking post-OLT.