Long term follow-up and outcome of liver transplantation for alcoholic liver disease: a single center case-control study.
BACKGROUND
Alcoholic liver cirrhosis (ALC) is a leading indication for orthotopic liver transplantation (OLT).


OBJECTIVE
To investigate the long-term outcome of OLT for ALC compared with patients transplanted for hepatitis C virus (HCV) infection.


METHODS
From 1987 to 2001, 49 OLT were performed for ALC and 173 for HCV. From these contemporary groups we matched 1:2 ALC patients (cases) to 98 HCV (controls). The following variables were analyzed: survival, retransplantation, rejection, primary nonfunction, infections, de novo tumors, cardiovascular and neurologic complications, and alcoholic recurrence.


RESULTS
Actuarial survival rate at 9 years was comparable for cases and controls. Actuarial graft survival rate at 9 years was significantly higher in cases (78% vs. 60%; P=0.026). The retransplantation rate was higher in controls (21% vs. 4%; P=0.007). Post-OLT complications were not significantly different. The alcoholic recidivism rate was 28% without influence on patients or graft survival, whereas relapse of HCV caused the majority of death in controls (30%; P=0.042). At multivariate analysis retransplantation was the only predictor of patient survival (odds ratio: 4.35; 95% confidence interval: 2.16-8.74; P<0.001), whereas HCV was associated with a 2-fold probability of graft failure (odds ratio: 1.97; 95% confidence interval: 1.02-3.81; P=0.032).


CONCLUSIONS
The long-term outcome of OLT for ALC is comparable to that for HCV, even if graft survival is significantly better among ALC. These data support ALC as an excellent indication for OLT.
Biselli
Maurizio
M
Department of Clinical Medicine, University of Bologna, Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Gramenzi
Annagiulia
A
Del Gaudio
Massimo
M
Ravaioli
Matteo
M
Vitale
Giovanni
G
Gitto
Stefano
S
Grazi
Gian Luca
GL
Pinna
Antonio Daniele
AD
Andreone
Pietro
P
Bernardi
Mauro
M
D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006526:Hepatitis C / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome