Negative impact of de novo malignancies rather than alcohol relapse on survival after liver transplantation for alcoholic cirrhosis: a retrospective analysis of 305 patients in a single center.
OBJECTIVE
Alcoholic liver disease is a leading indication for liver transplantation (LT). The aim of this study was to evaluate long-term results and survival prognostic factors of LT in this indication from a large cohort of patients.


METHODS
From October 1990 to October 2005, 305 consecutive patients with alcoholic cirrhosis (from 594 patients presenting with cirrhosis, i.e., 51.3%) underwent LT in our center. There were 229 men and 76 women, with a median age of 50 yr (range 30-68). Clinical and biological variables with possible prognostic value were analyzed.


RESULTS
Global survival rate was 92.6% at 1 yr, 88.5% at 3 yr, 84.3% at 5 yr, and 73.4% at 10 yr, and was similar (P=0.78, log-rank test) to that of patients transplanted for other cirrhosis (88.8% at 1 yr, 84.1% at 3 yr, 80.6% at 5 yr, and 74.7% at 10 yr). Recurrence of alcohol consumption was observed in 37 patients (12.1%). De novo cancer occurred in 35 patients after LT (11.5%). Univariate analysis disclosed that male gender, history of smoking, and de novo carcinoma were significant survival prognostic factors (P<0.05, log-rank test).


CONCLUSIONS
Our results strongly confirm that alcoholic liver disease is an excellent indication for LT, but long-term survival is reduced because of other target-organ damage of both alcohol and tobacco, especially aero-digestive malignancies, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease.
Dumortier
Jérôme
J
Fédération des Spécialités Digestives, and Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France.
Guillaud
Olivier
O
Adham
Mustapha
M
Boucaud
Catherine
C
Delafosse
Bertrand
B
Bouffard
Yves
Y
Paliard
Pierre
P
Scoazec
Jean-Yves
JY
Boillot
Olivier
O
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome