ALCOHOL-USE AFTER LIVER-TRANSPLANTATION IN ALCOHOLICS - A CLINICAL COHORT FOLLOW-UP-STUDY

The purposes of this study were to determine among a cohort of long-te rm alcoholic survivors after Liver transplantation (1) the incidence o f alcohol use, (2) its effect on allograft integrity and extrahepatic health, and (3) the validity of the pretransplant alcohol prognosis sc reening process, Retrospective clinical cohort study of all alcoholic patients undergoing orthotopic liver transplantation at a single cente r from February 1987 until January 1991 with follow-up through Decembe r 1994, giving a median duration of follow-up of 63 months (range, 6-8 9 months). Multidisciplinary liver transplantation program at a tertia ry-care academic medical center, Fifty alcoholic, long-term liver tran splant recipients, The frequency of alcohol relapse, defined as any al cohol use in the period after transplantation, was determined by two q uestionnaire studies and by clinical follow-up, Allograft integrity wa s assessed by coded review of serial percutaneous allograft biopsies, Potential systemic effects of alcohol relapse were assessed by chart r eview, The alcohol prognosis screening process was evaluated by retros pectively comparing pretransplant estimates of putative indicators of alcoholism prognosis in posttransplant alcohol users and abstainers, T hirty-three recipients (66%) consistently denied any alcohol use throu ghout the duration of posttransplant follow-up, whereas 17 (34%) were identified as having consumed alcohol at least once since the transpla nt, There were no significant differences at the time of evaluation be tween abstainers and alcohol users in age, sex distribution, severity of liver dysfunction, median duration of abstinence, or University of Michigan alcoholism prognosis score, The median interval from transpla ntation to alcohol relapse was 17 months, with a range of 3 to 45 mont hs, Recurrent alcohol use was associated with significant medical comp lications sufficient to require admission to the hospital in 6 patient s, One patient died of graft dysfunction, noncompliance with immunosup pressant medications, and presumed graft rejection while drinking. Mil d or progressive hepatitis, which was the most common abnormality in p osttransplant liver biopsy findings, was equally distributed between b oth alcohol users and abstainers and sometimes occurred in the absence of antibody to hepatitis C virus antibodies, There was a similar freq uency of biopsy-proven acute cellular rejection in alcohol users and a bstainers, Typical histological features of alcoholic liver injury wer e present in posttransplant biopsies from 1 alcohol user only, Alcohol use by alcoholics is uncommon in the first 5 years after liver transp lantation, and alcohol-associated liver injury is unusual. Mild nonspe cific hepatitis is common in both alcohol users and nonusers alike, Am ong a small subset of alcoholic transplant recipients, drinking behavi or after liver transplantation is associated with considerable morbidi ty, requiring hospital admissions and occasionally leading to graft lo ss and death.