title: Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden: impact of structured management on recidivism.
abstract: OBJECTIVE
  No systematic evaluation has been performed previously in the Scandinavian countries on patients transplanted for alcoholic liver disease (ALD). Data are limited on the impact of structured management of the alcohol problem on the risk of recidivism following transplantation in ALD.
  
  
  METHODS
  A total of 103 ALD patients were compared with a control group of patients with non-alcoholic liver disease (NALD). The recidivism rates for ALD patients transplanted between 1988 and 1997 as well as after 1998 (institution of structured management) were compared.
  
  
  RESULTS
  The median follow-up was 31 (6-60) months in the ALD group and 37 (12-63) months in the control group (NS). The overall survival rates at 1- and 5 years were, respectively, 81% and 69% for the ALD group and 87% and 83% for the non-alcoholic group. The proportion of patients with Child-Pugh C (75%) was higher in ALD patients than in NALD patients (44%) (p<0.01). Thirty-two (33%) ALD patients resumed taking some alcohol after transplantation; 17 patients (18%) were heavy drinkers. A multivariate analysis showed that: sex, age, marital and employment status, benzodiazepine use and a history of illicit drug abuse did not predict the risk of alcohol relapse post-Tx. Nineteen out of 40 (48%) patients transplanted before the start of structured management had resumed alcohol but 13 (22%) out of 58 after this intervention (p=0.002).
  
  
  CONCLUSIONS
  ALD is a good indication for liver transplantation, with similar results in the ALD patients. Structured management of the alcohol problem before and after transplantation is important in minimizing the risk of recidivism.
authors.affiliation: Department of Internal Medicine, Section of Gastroenterology and Hepatology, SE-413 45 Gothenburg, Sweden. einar.bjornsson@medic.gu.se
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
authors.forename: Janet
authors.initials: J
authors.lastname: Olsson
authors.forename: Annika
authors.initials: A
authors.lastname: Rydell
authors.forename: Kerstin
authors.initials: K
authors.lastname: Fredriksson
authors.forename: Cathrina
authors.initials: C
authors.lastname: Eriksson
authors.forename: Clas
authors.initials: C
authors.lastname: Sjöberg
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.forename: Lars
authors.initials: L
authors.lastname: Bäckman
authors.forename: Maria
authors.initials: M
authors.lastname: Castedal
authors.forename: Styrbjörn
authors.initials: S
authors.lastname: Friman
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods*; D012008:Recurrence; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome