title: Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center.
abstract: BACKGROUND
  Many concerns about liver transplantation in alcoholic patients are related to the risk of alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit (AAU) was formed within the liver transplant center for the management of alcoholic patients affected by end-stage liver disease and included in the waiting list for transplantation. We evaluated retrospectively the impact of the AAU on alcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration of alcohol abstinence before transplant was evaluated as well.
  
  
  METHODS
  Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation. Clinical evaluation and management of alcohol use in these patients was provided by psychiatrists with expertise in addiction medicine not affiliated to the liver transplant center before 2002 (n = 37; group A), or by the clinical staff of the AAU within the liver transplant center starting from 2002 (n = 55; group B).
  
  
  RESULTS
  Group B, as compared with group A, showed a significantly lower prevalence of alcohol recidivism (16.4 vs. 35.1%; p = 0.038) and a significantly lower mortality (14.5 vs. 37.8%; p = 0.01). Furthermore, an analysis of group B patients with either ≥6 or <6 months of alcohol abstinence before transplantation showed no difference in the rate of alcohol recidivism (21.1 vs. 15.4%; p = ns).
  
  
  CONCLUSIONS
  The presence of an AAU within a liver transplant center reduces the risk of alcohol recidivism after transplantation. A pretransplant abstinence period <6 months might be considered, at least in selected patients managed by an AAU.
authors.affiliation: Department of Internal Medicine , Catholic University of Rome, Rome, Italy; Alcohol Addiction Unit , Institute of Internal Medicine, Catholic University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Addolorato
authors.forename: Antonio
authors.initials: A
authors.lastname: Mirijello
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leggio
authors.forename: Anna
authors.initials: A
authors.lastname: Ferrulli
authors.forename: Cristina
authors.initials: C
authors.lastname: D'Angelo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vassallo
authors.forename: Anthony
authors.initials: A
authors.lastname: Cossari
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: Raffaele
authors.initials: R
authors.lastname: Landolfi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agnes
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D000368:Aged; D064829:Alcohol Abstinence / Q000639:trends*; D057229:Alcoholics; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D001418:Baclofen / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D001418:Baclofen
keywords: Alcohol Addiction Unit; Alcohol Dependence; Alcohol Recidivism; Alcoholism; Orthotopic Liver Transplantation