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. 1998 Jul;43(1):140–145. doi: 10.1136/gut.43.1.140

Patterns of alcohol consumption after liver transplantation

H Tang 1, R Boulton 1, B Gunson 1, S Hubscher 1, J Neuberger 1
PMCID: PMC1727191  PMID: 9771419

Abstract

Background—Uncertainty exists about the extent and consequences of a return to alcohol consumption after liver transplantation for alcoholic liver disease (ALD). 
Aims—To determine the prevalence and consequences of alcohol consumption in patients transplanted for ALD. 
Methods—A retrospective case controlled study of all patients transplanted for ALD at the Queen Elizabeth Hospital, Birmingham, between 1987 and 1996. 
Results—Seventy patients with ALD were transplanted, of which 59 survived more than three months; 56 were interviewed. Twenty eight had consumed some alcohol after transplantation; for the nine "heavy drinkers" (HD), the median time to resumption of alcohol intake was six months and for the 19 "moderate drinkers" (MD) it was eight months. There was no significant difference in episodes of acute rejection or compliance with medication between those who were abstinent, MD, or HD. Histological evidence of liver injury was common in ALD patients who had returned to drink. Mild fatty change was found in 1/11 biopsy specimens from abstinent patients but moderate to severe fatty change and ballooned hepatocytes were seen in 3/5 MD and 2/5 HD specimens. Two HD patients had early fibrosis. One HD patient has died of alcohol related complications. 
Conclusions—Moderate to heavy alcohol consumption occurs in patients transplanted for ALD. Patient recall of abstinence advice is unreliable, and patients return to alcohol mainly within the first year after liver transplantation. Return to alcohol consumption after liver transplantation is associated with rapid development of histological liver injury including fibrosis. 



Keywords: alcohol consumption; liver transplantation

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Figure 1 .

Figure 1

Recidivism post-transplantation for ALD.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anand A. C., Ferraz-Neto B. H., Nightingale P., Mirza D. F., White A. C., McMaster P., Neuberger J. M. Liver transplantation for alcoholic liver disease: evaluation of a selection protocol. Hepatology. 1997 Jun;25(6):1478–1484. doi: 10.1002/hep.510250628. [DOI] [PubMed] [Google Scholar]
  2. Berlakovich G. A., Steininger R., Herbst F., Barlan M., Mittlböck M., Mühlbacher F. Efficacy of liver transplantation for alcoholic cirrhosis with respect to recidivism and compliance. Transplantation. 1994 Sep 15;58(5):560–565. doi: 10.1097/00007890-199409150-00006. [DOI] [PubMed] [Google Scholar]
  3. Bernard P. H., Le Bail B., Carles J., Balabaud C., Bioulac-Sage P. Liver retransplantation for alcoholic cirrhosis recurring within a 21-month period. Transpl Int. 1996;9(5):524–525. doi: 10.1007/BF00336836. [DOI] [PubMed] [Google Scholar]
  4. Bird G. L., O'Grady J. G., Harvey F. A., Calne R. Y., Williams R. Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse. BMJ. 1990 Jul 7;301(6742):15–17. doi: 10.1136/bmj.301.6742.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Candinas D., Gunson B. K., Nightingale P., Hubscher S., McMaster P., Neuberger J. M. Sex mismatch as a risk factor for chronic rejection of liver allografts. Lancet. 1995 Oct 28;346(8983):1117–1121. doi: 10.1016/s0140-6736(95)91797-7. [DOI] [PubMed] [Google Scholar]
  6. Foster P. F., Fabrega F., Karademir S., Sankary H. N., Mital D., Williams J. W. Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation. Hepatology. 1997 Jun;25(6):1469–1477. doi: 10.1002/hep.510250627. [DOI] [PubMed] [Google Scholar]
  7. Gerhardt T. C., Goldstein R. M., Urschel H. C., Tripp L. E., Levy M. F., Husberg B. S., Jennings L. W., Gonwa T. A., Klintmalm G. B. Alcohol use following liver transplantation for alcoholic cirrhosis. Transplantation. 1996 Oct 27;62(8):1060–1063. doi: 10.1097/00007890-199610270-00005. [DOI] [PubMed] [Google Scholar]
  8. Gish R. G., Lee A. H., Keeffe E. B., Rome H., Concepcion W., Esquivel C. O. Liver transplantation for patients with alcoholism and end-stage liver disease. Am J Gastroenterol. 1993 Sep;88(9):1337–1342. [PubMed] [Google Scholar]
  9. Goldstein R., Tripp L., Clemmons J., Husberg B., Gonwa T. A., Polter D., Klintmalm G. Liver transplantation for alcoholic cirrhosis--do they mix? Transplant Proc. 1993 Feb;25(1 Pt 2):1131–1132. [PubMed] [Google Scholar]
  10. Howard L., Fahy T., Wong P., Sherman D., Gane E., Williams R. Psychiatric outcome in alcoholic liver transplant patients. QJM. 1994 Dec;87(12):731–736. doi: 10.1093/oxfordjournals.qjmed.a068890. [DOI] [PubMed] [Google Scholar]
  11. Knechtle S. J., Fleming M. F., Barry K. L., Steen D., Pirsch J. D., Hafez G. R., D'Alessandro A. M., Reed A., Sollinger H. W., Kalayoglu M. Liver transplantation for alcoholic liver disease. Surgery. 1992 Oct;112(4):694–703. [PubMed] [Google Scholar]
  12. Krom R. A. Liver transplantation and alcohol: who should get transplants? Hepatology. 1994 Jul;20(1 Pt 2):28S–32S. doi: 10.1016/0270-9139(94)90270-4. [DOI] [PubMed] [Google Scholar]
  13. Kumar S., Stauber R. E., Gavaler J. S., Basista M. H., Dindzans V. J., Schade R. R., Rabinovitz M., Tarter R. E., Gordon R., Starzl T. E. Orthotopic liver transplantation for alcoholic liver disease. Hepatology. 1990 Feb;11(2):159–164. doi: 10.1002/hep.1840110202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lucey M. R., Merion R. M., Henley K. S., Campbell D. A., Jr, Turcotte J. G., Nostrant T. T., Blow F. C., Beresford T. P. Selection for and outcome of liver transplantation in alcoholic liver disease. Gastroenterology. 1992 May;102(5):1736–1741. doi: 10.1016/0016-5085(92)91737-o. [DOI] [PubMed] [Google Scholar]
  15. Morse R. M., Flavin D. K. The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism. JAMA. 1992 Aug 26;268(8):1012–1014. doi: 10.1001/jama.268.8.1012. [DOI] [PubMed] [Google Scholar]
  16. Moss A. H., Siegler M. Should alcoholics compete equally for liver transplantation? JAMA. 1991 Mar 13;265(10):1295–1298. [PubMed] [Google Scholar]
  17. Neuberger J., Tang H. Relapse after transplantation: European studies. Liver Transpl Surg. 1997 May;3(3):275–279. doi: 10.1002/lt.500030313. [DOI] [PubMed] [Google Scholar]
  18. Osorio R. W., Ascher N. L., Avery M., Bacchetti P., Roberts J. P., Lake J. R. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hepatology. 1994 Jul;20(1 Pt 1):105–110. doi: 10.1016/0270-9139(94)90141-4. [DOI] [PubMed] [Google Scholar]
  19. Padbury R. T., Gunson B. K., Dousset B., Hubscher S. G., Buckels J. A., Neuberger J. M., Elias E., McMaster P. Steroid withdrawal from long-term immunosuppression in liver allograft recipients. Transplantation. 1993 Apr;55(4):789–794. doi: 10.1097/00007890-199304000-00020. [DOI] [PubMed] [Google Scholar]
  20. Pageaux G. P., Souche B., Perney P., Calvet B., Delande G., Fabre J. M., Domergue J., Larrey D., Michel H. Results and cost of orthotopic liver transplantation for alcoholic cirrhosis. Transplant Proc. 1993 Feb;25(1 Pt 2):1135–1136. [PubMed] [Google Scholar]
  21. Poynard T., Barthelemy P., Fratte S., Boudjema K., Doffoel M., Vanlemmens C., Miguet J. P., Mantion G., Messner M., Launois B. Evaluation of efficacy of liver transplantation in alcoholic cirrhosis by a case-control study and simulated controls. Lancet. 1994 Aug 20;344(8921):502–507. doi: 10.1016/s0140-6736(94)91897-x. [DOI] [PubMed] [Google Scholar]
  22. Raakow R., Langrehr J. M., Lohmann R., Knoop M., Keck H., Kling N., Neuhaus R., Blumhardt G., Bechstein W. O., Neuhaus P. Is orthotopic liver transplantation for end-stage alcoholic cirrhosis justified? Transplant Proc. 1995 Feb;27(1):1241–1242. [PubMed] [Google Scholar]
  23. Radosavljevic M., Temsch E., Hammer J., Pfeffel F., Mayer G., Renner F., Pidlich J., Muller C. Elevated levels of serum carbohydrate deficient transferrin are not specific for alcohol abuse in patients with liver disease. J Hepatol. 1995 Dec;23(6):706–711. doi: 10.1016/0168-8278(95)80037-9. [DOI] [PubMed] [Google Scholar]
  24. Saló J., Ginès A., Anibarro L., Jiménez W., Bataller R., Clària J., Ginès P., Rivera F., Arroyo V., Rodés J. Effect of upright posture and physical exercise on endogenous neurohormonal systems in cirrhotic patients with sodium retention and normal supine plasma renin, aldosterone, and norepinephrine levels. Hepatology. 1995 Aug;22(2):479–487. doi: 10.1002/hep.1840220217. [DOI] [PubMed] [Google Scholar]
  25. Sherlock S. Alcoholic liver disease. Lancet. 1995 Jan 28;345(8944):227–229. doi: 10.1016/s0140-6736(95)90226-0. [DOI] [PubMed] [Google Scholar]
  26. Starzl T. E., Van Thiel D., Tzakis A. G., Iwatsuki S., Todo S., Marsh J. W., Koneru B., Staschak S., Stieber A., Gordon R. D. Orthotopic liver transplantation for alcoholic cirrhosis. JAMA. 1988 Nov 4;260(17):2542–2544. [PMC free article] [PubMed] [Google Scholar]
  27. Stevens L., Piper J., Emond J., Heffron T., Baker A., Broelsch C. Liver transplantation for controversial indications: alcoholic liver disease, hepatic cancers, and viral hepatitis. Transplant Proc. 1991 Jun;23(3):1915–1916. [PubMed] [Google Scholar]

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