Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus

Background. Liver transplantation (LTx) for alcohol-related liver disease ( ALD) is an accepted modality of treatment and is one of the most common ind ications for LTx in the United States. The present report examines the long -term patient survival, graft survival, rates of recidivism, and developmen t of de novo cancers in this group, and compares these results with a conte mporaneous group of patients who were transplanted for non-ALD indications. Methods, Between August 1989 and December 1992, 185 adults received LTx for ALD (group I). During the same time interval, 649 adults received LTx for non-ALD (group II). The mean follow-up time was 94 +/- 10.7 months for grou p I vs. 92 +/- 11 months for group II. Kaplan-Meier survival estimates and the incidence of cancers using Surveillance Epidemiologic End Result data w ere compared in both groups. Results, At 5 years after orthotopic LTx, the overall patient survival and graft survival for group I were 72.0% and 66.5% vs. 66.5% and 60.3% for gro up II, respectively. After 5 years, the patient survival and graft survival for the alcoholic group were significantly lower (P = 0.001) compared to t he non-alcoholic group, The rate of de novo oropharyngeal cancer and lung c ancer was 25.5 times and 3.7 times higher, respectively, in ALD group compa red with the general population matched for age, sex, and length of follow- up (P = 0,001), whereas this was not higher in the non-ALD group. Prior pre transplant length of sobriety and alcohol rehabilitation was not associated with the rate of post-LTx rate of recidivism, which was 20%, Out of 79 dea ths in group I, only 1 was attributed to recidivism and 3 to noncompliance with recidivism, The other deaths occurred from de novo cancer (n = 13), po sttransplant lymphoproliferative disorder (n = 5), age-related complication s (n = 23), and other infection or miscellaneous causes (n = 34), Conclusions. Patient and graft survival past 5 years after orthotopic LTx i s significantly lower for ALD for a variety of reasons (P = 0.001). The rat e of upper airway malignances was significantly higher in ALD patients than for non-ALD post-LTx patients and the general public. Graft loss/death rel ated to recidivism or chronic rejection was extremely low. More attention i s needed for early diagnosis of de novo cancer and prevention of cardioresp iratory and cerebrovascular complications.