Academic journal article Alcohol Research

Liver Transplantation for Alcoholic Liver Disease

Academic journal article Alcohol Research

Liver Transplantation for Alcoholic Liver Disease

Article excerpt

In many patients, long-term heavy drinking leads to chronic liver disease, liver failure, and even death. Orthotopic liver transplantation (OLT) is the only definitive treatment for end-stage liver disease, including alcoholic liver disease (ALD). Because of a shortage of donor organs, OLT for ALD patients remains controversial out of concerns that patients may resume drinking, thereby harming the transplanted organ. Therefore, transplant centers conduct careful screening procedures that assess patients' coexisting medical problems and psychosocial status to identify those patients who are medically most suited for the procedure and who are most likely to remain abstinent after OLT. Studies assessing the outcomes of ALD patients after OLT found that the survival rates of the transplanted organ and the patient were comparable to those of patients with nonalcoholic liver disease and that relapse rates among the ALD patients were low. Similarly, ALD patients and patients with other types of liver disease had comparable rates of compliance with complex medication regimens after OLT. Enhanced efforts to identify risk factors for relapse among OLT candidates with ALD and to target interventions specifically to those patients who are at high risk of relapse may further improve patient outcome and enhance the acceptance of OLT for alcoholic patients in the general population. KEY WORDS: alcoholic liver disorder; organ transplantation; liver; patient assessment; patient compliance; comorbidity; cardiomyopathy; pancreatitis; malnutrition; hepatocellular carcinoma; AODR (alcohol and other drug related) structural brain damage; bone mineral density; hepatitis C virus; AOD abstinence; alcohol use test treatment outcome; quality of life; AODD (alcohol and other drug dependence) relapse; predictive factor; patient monitoring; medical ethics

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Population-based surveys indicate that 68 percent of adult Americans drink at least one alcoholic beverage per month. About 10 percent consume more than two drinks per day, which is a commonly used definition of "heavy drinking" (Hoofnagle et al. 1997). However, substantial differences exist in the prevalence of heavy drinking among population subgroups. For example, 18 percent of men but only 3 percent of women are classified as heavy drinkers, and heavy drinking is more common among Whites than among African Americans or Hispanics. Heavy drinking and its consequences are important public health problems, as illustrated by the following statistics:

* Five percent of the deaths occurring annually in the United States (approximately 100,000 per year) are either directly or indirectly attributable to alcohol abuse (Hoofnagle et al. 1997).

* Only about 10 percent of all drinkers account for 50 percent of the total alcohol consumption in the United States per year (Li 1997).

* About 13.8 million people in the United States meet the diagnostic criteria for alcohol abuse or dependence specified in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (Grant et al. 1994).

* About 15 percent of U.S. alcoholics eventually will develop alcoholic liver disease (ALD), a broad spectrum of liver injuries--ranging from asymptomatic fatty liver (i.e., steatosis) or abnormalities of liver enzymes to end-stage liver disease--that result from alcohol ingestion. Women in general show greater susceptibility to ALD than men, and African Americans show greater susceptibility than Whites.

* Among heavy drinkers, liver disease is highly prevalent. Thus, 90 to 100 percent of heavy drinkers have steatosis, 10 to 35 percent have alcohol-induced inflammation of the liver (i.e., alcoholic hepatitis), and 8 to 20 percent have alcoholic cirrhosis (McCullough 1999).

* The 5-year and 10-year survival rates for patients with alcoholic cirrhosis are 23 percent and 7 percent, respectively (McCullough 1999). …

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