Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis

Background, The majority of liver transplant centers require a 6-month abst inence period before listing candidates for Liver transplantation with alco holic cirrhosis and a persistent sobriety thereafter. We attempted to ident ify risk factors for failure to comply with these requirements Methods, Ninety-nine consecutive patients with alcoholic cirrhosis were ref erred for liver transplant evaluation between September 1996 and May 1998, The mean age was 49 years, 74% were male, and 54% were hepatitis C virus po sitive. To be Listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently mo nitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the Liver transplant waiting list. Detailed p atient information was entered into a computerized database, and 36 discree t variables were analyzed in relation to success (patient Listed and remain ed on the List) or failure (not listed or removed from the list based on no ncompliance). Results, Forty-nine patients were successfully listed, Nineteen received a transplant, with a 95% 1-year patient and graft survival rate and 21% alcoh ol relapse rate after transplantation, Twenty-two patients had either medic al contraindication and/or died before transplant listing, Twenty-four pati ents were never Listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identifie d five significant risk factors for failure: (I) living arrangement (alone/ family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluatio n, P=0.001; and (V) failure to accept further alcoholic rehabilitation befo re orthotopic liver transplantation, P=0.01, Conclusions. Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis, We ident ified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.