Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease.
With appropriate selection criteria, patients with end-stage alcoholic liver disease who undergo orthotopic liver transplantation have similar graft and patient survivals as patients undergoing transplantation for other causes. However, because of the possibility of recidivism after orthotopic liver transplantation there is still reluctance to transplant alcoholic patients. This study examined the association between pretransplant psychosocial variables and the risk of recidivism after orthotopic liver transplantation. At our institution, 43 patients received orthotopic liver transplantation for the referral diagnosis of alcoholic liver disease from February 1, 1988 to May 1, 1991. This represented 17% of all first transplants (43 of 257) performed during this period. Patients were interviewed before orthotopic liver transplantation by a single psychiatrist and responses to a defined set of questions were entered into a clinical database. All 43 patients diagnosed with alcoholic liver disease and a comparison group of patients transplanted for diagnoses other than alcoholic liver disease received a postoperative questionnaire regarding past and present alcohol use. Patients enrolled in the study all had at least 7 mo of follow-up, with the median follow-up being 21 mo. Eighty-six percent of alcoholic liver disease patients (37 of 43) and 86% of patients in the comparison group (37 of 43) of ALD patients agreed to participate in the study. Nineteen percent of alcoholic liver disease patients (7 of 37) and 24% of patients in the comparison group (9 of 37) admitted to having used alcohol after orthotopic liver transplantation, wtih 8% (3 of 37) and 11% (4 of 37) currently using alcohol, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgery, University of California, San Francisco 94143.
R W
RW
Osorio
N L
NL
Ascher
M
M
Avery
P
P
Bacchetti
J P
JP
Roberts
J R
JR
Lake
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D000437:Alcoholism / Q000523:psychology* / Q000534:rehabilitation; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D016031:Liver Transplantation / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D012008:Recurrence; D012044:Regression Analysis; D013695:Temperance