Outcomes following liver transplantation for patients with alcohol- versusnonalcohol-induced liver disease

OBJECTIVE: To document and compare the outcomes of adult patients who recei ved liver transplants for alcohol- and nonalcohol-induced liver diseases wh o attended a liver transplantation follow-up clinic in an urban, nontranspl antation centre at a time when no formal alcohol abuse program for transpla nt candidates and/or recipients was offered. PATIENTS AND METHODS: The study population comprised 10 alcoholic patients and 48 nonalcoholic patients followed for an average of 41 months (range fi ve to 79 months) and 46 months (range two to 116 months), respectively. Pri mary outcome variables included rates of recidivism, duration of abstinence after transplantation and compliance with post-transplant medical follow-u p visits. Time to discharge after transplantation, episodes of graft reject ion, liver and renal biochemical abnormalities, diabetes, hypertension, sep sis, strictures, complications unrelated to transplantation and changes in psychosocial status were secondary outcome variables. RESULTS: Significant differences were found with respect to a higher incide nce of recidivism (50% for alcoholic patients compared with 2% for nonalcoh olic patients, P<0.0001), a shorter period of abstinence after transplantat ion (14.1+/-11.2 months for alcoholic patients compared with 26.3+/-23.0 mo nths for nonalcoholic patients, P<0.05) and more missed office visits (2.7/-3.5 for alcoholic patients compared with 1.0+/-1.9 for nonalcoholic patie nts, P=0.05) in the alcoholic group. The alcoholic group also had a lower i ncidence of rejection episodes (10% for alcoholic patients compared with 44 % for nonalcoholic patients, P<0.05) but higher rates of post-transplantati on diabetes (40% for alcoholic patients compared with 2% for nonalcoholic p atients, P<0.05), more nontransplantation-related complications (20% for al coholic patients compared with 0% for nonalcoholic patients, P<0.05), and h igher serum creatinine but lower bilirubin and cyclosporine A levels (P<0.0 5, respectively). Marital separations were also more common in the alcoholi c group (20% for alcoholic patients compared with 0% for nonalcoholic patie nts, P<0.05). CONCLUSIONS: In the absence of formal alcohol abuse programs, the post-tran splantation outcome in alcoholic patients generally does not compare well w ith that of patients who undergo transplantation for nonalcohol-related liv er diseases.