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Gut. 2007 May; 56(5): 735–736.
Published online 2006 December 4. doi:  10.1136/gut.2006.115022
PMCID: PMC1942147

Transplantation for alcoholic liver disease

Alcohol relapse can negatively influence the outcome after liver transplantation and factors that could be associated with the recurrence of harmful alcohol consumption after liver transplantation are still poorly described. We recently presented the results of a study1 dealing with this issue in a large cohort of patients transplanted for alcoholic liver disease. Our findings are in accordance with the observations by O'Grady in a recent leading article in Gut,2 but expand to some novel aspects, which we would like to focus on.

In all, 387 consecutive patients, transplanted for alcoholic cirrhosis in Geneva and Lyon, were followed up for a mean duration of 61.2 months. Relapse of harmful alcohol consumption after liver transplantation was observed in 11.9%. In univariate analysis, return to harmful alcohol drinking—defined as a daily consumption >40 g associated with physical or mental damage related to alcohol,3 was significantly associated with age >50 years (p = 0.04), duration of abstinence <6 months (p = 0.02), psychiatric comorbidities (p<0.001), absence of a life partner (p<0.05) and an increased high‐risk alcohol relapse4 (HRAR) score (p<0.001). Alcohol relapse was 6.6% in patients without psychiatric comorbidities and up to 69.6% in patients with psychiatric comorbidities (p<0.001). Multivariate logistic regression disclosed that duration of abstinence <6 months (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2 to 9.3, p = 0.02), psychiatric comorbidities (OR 7.8, 95% CI 3.1 to 20, p<0.001) and high‐risk alcohol relapse score >3 (OR 10.7, 95% CI 3.8 to 30, p<0.001) were independent factors of relapse. In patients presenting none of these factors, alcohol relapse was 4.8%, whereas the presence of 1, 2 or 3 factors together was associated with relapse in 17.8%, 63.6% and 100% of the patients, respectively.

Although the results of this study support the validity of the 6‐month abstinence rule, they relegate it behind two other major factors, which are susceptible of predicting relapse. As a consequence, we only partially share the author's position for the endorsement of this rule, as it appears to be an insufficient element of decision, when considered as the sine qua non condition for a favourable assessment. Additionally, we believe that obtaining accurate information on the general population about the limits of this rule would be preferable to a rigid requirement based on debated evidence. The availability of additional parameters, as suggested in our study, to predict return to heavy drinking after liver transplantation will probably help us to use organs to the best of their potential. The data of the present study, although waiting to be independently validated, may provide novel insights into the criteria for the selection of patients with alcoholic liver disease, who are candidates for liver transplantation, and may facilitate our future decisions.

Footnotes

Competing interests: None.

References

1. De Gottardi A, Spahr L, Gelez P. et al Is alcohol relapse after liver transplantation predictable? Results in 387 patients over 15 years [abstract 1428]. Am J Transplant 2006. 6546
2. O'Grady J G. Liver transplantation alcohol related liver disease: (deliberately) stirring a hornet's nest! Gut 2006. 551529–1531.1531 [PMC free article] [PubMed]
3. ICD Version 2006: World Health Organization 2006
4. Yates W R, Booth B M, Reed D A. et al Descriptive and predictive validity of a high‐risk alcoholism relapse model. J Stud Alcohol 1993. 54645–651.651 [PubMed]

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