Liver transplantation for alcoholic cirrhosis: Long term follow-up and impact of disease recurrence

Background. Alcoholic liver disease has emerged as a leading indication for hepatic transplantation, although it is a controversial use of resources. We aimed to examine all aspects of liver transplantation associated with al cohol abuse. Methods. Retrospective cohort analysis of 123 alcoholic patients with a med ian of 7 years follow-up at one center. Results. In addition to alcohol, 43 (35%) patients had another possible fac tor contributing to cirrhosis. Actuarial patient and graft survival rates w ere, respectively, 84% and 81% (1 year); 72% and 66% (5 years); and 63% and 59% (7 years). After transplantation, 18 patients (15%) manifested 21 nonc utaneous de novo malignancies, which is significantly more than controls (P =0.0001); upper aerodigestive squamous carcinomas were overrepresented (P=0 .03). Thirteen patients had definitely relapsed and three others were suspe cted to have relapsed. Relapse was predicted by daily ethanol consumption ( P=0.0314), but not by duration of pretransplant sobriety or explant histolo gy. No patient had alcoholic hepatitis after transplantation and neither la te onset acute nor chronic rejection was significantly increased. Multiple regression analyses for predictors of graft failure identified major biliar y/vascular complications (P=0.01), chronic bile duct injury on biopsy (P=0. 002), and pericellular fibrosis on biopsy (P=0.05); graft viral hepatitis w as marginally significant (P=0.07) on univariate analysis. Conclusions. Alcoholic liver disease is an excellent indication for liver t ransplantation in those without coexistent conditions. Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure . Potential recipients should be heavily screened before transplantation fo r coexistent conditions (e.g., hepatitis C, metabolic diseases) and other t arget-organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease.