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Alcoholic Liver Disease
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Liver Transplantation
Liver transplantation currently is the only definitive treatment for severe (end stage) liver failure. A total of 41,734 liver transplants using organs from cadavers were performed in the United States between 1992 and 2001. Of these, 12.5 percent were performed in patients with Alcoholic Liver Disease (ALD), and 5.8 percent were performed in patients with ALD and a concurrent infection with the hepatitis C virus (HCV), making ALD the second most frequent reason (after HCV infection alone) for transplantation.
ALD patients must undergo a thorough evaluation to determine whether they are suitable candidates for transplant. This screening addresses any coexisting medical problems, such as heart damage, cancer, pancreatitis, and osteoporosis, which might influence the outcome of the transplant. It includes a psychological evaluation to identify those patients who are most likely to remain abstinent and comply with the strict medical regimen that follows the procedure.
For transplantation to be successful in alcoholic patients it is essential that they remain abstinent after the surgery and comply with a demanding medical regimen. For example, consistently take the necessary antirejection medications. Routinely conducting psychiatric evaluations before patients are included on the list of candidates for transplantation helps to identify those who may not be able to meet these criteria.
Because of the shortage of donated organs, transplantation to patients with alcoholic liver disease remains controversial, mainly out of concern that the transplanted liver could be "wasted" if a patient relapses to drinking and damages the new liver as well. Yet the relapse rates in patients following transplant are lower than in patients undergoing alcoholism treatment, and serious relapses that adversely affect the transplanted liver or the patient are uncommon. In contrast, patients who receive a transplant because of an infection with hepatitis B or C viruses typically experience disease recurrence and are more likely to lose the transplanted liver because of recurrence of these infections.
Another concern is that patients with ALD will not be able to comply with the antirejection medication regimen, but this has not been supported by research. Liver rejection rates are similar for patients transplanted for ALD and those transplanted for other types of liver disease, indicating comparable rates of compliance with the antirejection medications. Finally, it was believed that ALD patients would use more resources, thereby incurring higher costs than non-ALD patients, but again this assumption has not been corroborated by research evidence.
In contrast to these negative assumptions on the use of liver transplants in ALD patients, many clinicians contend that ALD is, in fact, an excellent reason for liver transplantation. The overall improvement in patients with ALD after transplant, including higher productivity and better quality of life, supports considering these patients for liver transplants. Moreover, the long-term costs of transplantation and subsequent management of the alcoholic patient may well be lower than the costs of managing alcoholism and ALD without transplantation.
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References:
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
January 2005
pubs.niaaa.nih.gov
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