title: Excessive alcohol consumption after liver transplantation impacts on long-term survival, whatever the primary indication.
abstract: OBJECTIVE
  Beyond 5 years, poorer survival, related to alcohol relapse, is observed in patients with liver transplant for alcohol-related liver disease (ALD). However, alcohol consumption has been significantly understudied in non-ALD transplant recipients. We aimed at analyzing the impact of alcohol consumption on long-term survival irrespective of the indication for transplantation.
  
  
  METHODS
  This observational study included consecutive adult recipients of a primary liver graft between 1991 and 2007 in our hospital, who survived >6 months. Patients without ALD as primary indication, but with a history of excessive alcohol consumption before transplantation, were classified as secondary indication ALD. We studied the impact on survival of excessive consumption of alcohol after transplantation and several other variables.
  
  
  RESULTS
  The 441 patients had mean follow-up of 81.7 months. Among the 281 patients with excessive alcohol consumption before transplantation, 206 had ALD as primary indication. After transplantation, alcohol consumption was reported by 32.3% of the study population, 43.7% in primary indication ALD, and 24.3% in non-ALD patients. Survival was 82% at 5 years and 49% at 10 years for patients with excessive alcohol relapse, compared with 86% and 75%, respectively, for patients without persistent excessive alcohol relapse. By multivariable analysis, the independent risk factors of death were: excessive alcohol relapse, age >51 years, post-transplantation diabetes mellitus, cyclosporine-based immunosuppression, and non-hepatic cancer.
  
  
  CONCLUSIONS
  Excessive alcohol consumption has a negative impact on long-term survival after liver transplant, irrespective of the primary indication. Death is mainly due to recurrence of liver disease and non-hepatic cancer.
authors.affiliation: Liver Transplantation Unit, CHU Saint Eloi, Montpellier, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Faure
authors.forename: Astrid
authors.initials: A
authors.lastname: Herrero
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Yohan
authors.initials: Y
authors.lastname: Duny
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daures
authors.forename: Thibaut
authors.initials: T
authors.lastname: Mura
authors.forename: Eric
authors.initials: E
authors.lastname: Assenat
authors.forename: Michaël
authors.initials: M
authors.lastname: Bismuth
authors.forename: Hassan
authors.initials: H
authors.lastname: Bouyabrine
authors.forename: Hélène
authors.initials: H
authors.lastname: Donnadieu-Rigole
authors.forename: Francis
authors.initials: F
authors.lastname: Navarro
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Dominique
authors.initials: D
authors.lastname: Larrey
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D015996:Survival Rate