title: Liver transplantation for alcoholic liver disease among Canadian transplant centres: a national study.
abstract: BACKGROUND⁄
  
  
  OBJECTIVE
  Alcoholic liver disease (ALD) is a controversial yet established indication for liver transplantation (LT), and there is emerging evidence supporting a survival benefit in selected patients with severe acute alcoholic hepatitis. The aim of the present survey was to describe policies among Canadian transplant centres for patients with ALD.
  
  
  METHODS
  A survey was distributed to the medical directors of all seven liver transplant centres in Canada.
  
  
  RESULTS
  All seven liver transplant programs in Canada participated in the survey. Every centre requires patients to have a minimum of six months of abstinence from alcohol before listing for LT. Completion of a rehabilitation program is only mandatory in one program; the remaining programs do not mandate this if patients have demonstrated prolonged abstinence, and sufficient insight and social supports. No program considers LT for patients with severe acute alcoholic hepatitis, although six of the seven programs are interested in exploring a national policy. Random alcohol checks for waitlisted patients are performed routinely on patients listed for ALD at only one centre; the remaining centres only perform checks if there is clinical suspicion. In the past five years, the mean (± SD) number of patients per centre with graft dysfunction from recidivism was 10±4.36; a mean of 2.5±4.36 patients per centre developed graft failure.
  
  
  CONCLUSIONS
  With minor exceptions, LT policies for subjects with ALD are uniform across Canadian transplant programs. Presently, no centres perform LT for acute alcoholic hepatitis, although there is broad interest in exploring a national policy. Recidivism resulting in graft loss is a rare phenomenon.
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljawad
authors.forename: Angela
authors.initials: A
authors.lastname: White
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000208:Acute Disease; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D000437:Alcoholism / Q000150:complications / Q000534:rehabilitation*; D002170:Canada; D019538:Health Care Surveys; D006519:Hepatitis, Alcoholic / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D018579:Patient Selection; D012720:Severity of Illness Index; D012944:Social Support; D013695:Temperance; D013997:Time Factors; D014850:Waiting Lists
references.citation: Liver Transpl. 2011 May;17(5):539-47
references.pmid: 21506242
references.citation: Liver Transpl. 2001 May;7(5):418-27
references.pmid: 11349262
references.citation: Scand J Gastroenterol. 2011 Oct;46(10):1257-66
references.pmid: 21815863
references.citation: Gastroenterol Clin North Am. 2011 Sep;40(3):611-39
references.pmid: 21893277
references.citation: J Med Philos. 1998 Feb;23(1):31-49
references.pmid: 9555633
references.citation: JAMA. 1991 Mar 13;265(10):1295-8
references.pmid: 1995977
references.citation: Gastroenterol Hepatol (N Y). 2011 Sep;7(9):585-90
references.pmid: 22298997
references.citation: Hastings Cent Rep. 2007 Jan-Feb;37(1):41-7
references.pmid: 17348263
references.citation: Liver Transpl. 2010 Jan;16(1):91-7
references.pmid: 19866447
references.citation: Semin Liver Dis. 2007 Feb;27(1):44-54
references.pmid: 17295176
references.citation: Hepatology. 2012 May;55(5):1398-405
references.pmid: 22213344
references.citation: Gastroenterology. 1978 Aug;75(2):193-9
references.pmid: 352788
references.citation: Bioethics. 2008 Feb;22(2):77-83
references.pmid: 18251767
references.citation: Dig Liver Dis. 2011 Nov;43(11):843-9
references.pmid: 21550324
references.citation: Liver Transpl. 2007 May;13(5):757-61
references.pmid: 17457868
references.citation: N Engl J Med. 2011 Nov 10;365(19):1790-800
references.pmid: 22070476
references.citation: Can J Gastroenterol. 2010 Apr;24(4):245-50
references.pmid: 20431813
references.citation: Transplantation. 2008 Oct 27;86(8):1090-5
references.pmid: 18946347
references.citation: Liver Transpl. 2005 Apr;11(4):420-6
references.pmid: 15776421
references.citation: Liver Transpl. 2006 Jul;12(7):1049-61
references.pmid: 16799946
references.citation: Am J Gastroenterol. 2009 Jul;104(7):1700-6
references.pmid: 19471253
references.citation: Br J Surg. 1973 Aug;60(8):646-9
references.pmid: 4541913
references.citation: Ann Hepatol. 2011 Oct-Dec;10(4):477-81
references.pmid: 21911888