title: Recurrent alcoholic cirrhosis in severe alcoholic relapse after liver transplantation: a frequent and serious complication.
abstract: OBJECTIVE
  Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT). Recurrent alcoholic cirrhosis (RAC) after LT can occur but has not been studied. The aims of this study were to estimate the prevalence, predictive factors, and natural history of RAC after LT.
  
  
  METHODS
  All patients transplanted for ALD between 1990 and 2007 in three French centers were included. The diagnosis of RAC was based on histological evidence or a series of features combined with severe alcoholic relapse.
  
  
  RESULTS
  Among 1,894 adult LT patients, 712 were transplanted for alcoholic cirrhosis and survived >6 months. After a mean follow-up of 9 years, 128 patients (mean age at LT 47.2±7.1 years old, 78.9% men) experienced severe alcoholic relapse (18.0% of cases). Severe alcoholic relapse occurred after a median delay of 25 months (range 4-157) after LT. RAC was diagnosed in 41 patients with severe relapse (32%). The diagnosis of RAC was made after a median delay of 5.1 years (range 1.8-13.9) after LT and of 4.0 years (range 1.2-11.5) after relapse. RAC was significantly associated with younger age and a shorter period of pre-LT abstinence. One-, 5-, 10-, and 15-year survival was 100, 87.6, 49.7, and 21.0%, respectively, for RAC patients vs. 100, 89.4, 69.9, and 41.1%, respectively, for the patients without RAC (P<0.001).
  
  
  CONCLUSIONS
  RAC occurs in <6% of ALD transplant patients. One-third of severe alcoholic relapse patients develop RAC <5 years after transplantation with a very poor prognosis.
authors.affiliation: 1] Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France [2] Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.affiliation: 1] Maladies de l'appareil digestif et de la Nutrition, Pôle médico-chirurgical Huriez, Lille, France [2] Université Lille 2, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.affiliation: Maladies de l'appareil digestif et de la Nutrition, Pôle médico-chirurgical Huriez, Lille, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Cannesson
authors.affiliation: Maladies de l'appareil digestif et de la Nutrition, Pôle médico-chirurgical Huriez, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lassailly
authors.affiliation: Maladies de l'appareil digestif et de la Nutrition, Pôle médico-chirurgical Huriez, Lille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rolland
authors.affiliation: 1] Université Lille 2, Lille, France [2] Service de chirurgie digestive et transplantation, Pôle médico-chirurgical Huriez, Hôpital Claude Huriez, Lille, France.
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.affiliation: 1] Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France [2] Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.affiliation: Unité de Transplantation hépatique, Pôle Digestif, CHU Saint-Eloi, Montpellier, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Faure
authors.affiliation: Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Unité de Transplantation hépatique, Pôle Digestif, CHU Saint-Eloi, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Rigole-Donnadieu
authors.affiliation: Unité de Transplantation hépatique, Pôle Digestif, CHU Saint-Eloi, Montpellier, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Herrero
authors.affiliation: 1] Université Claude Bernard Lyon 1, Lyon, France [2] Service d'anatomie et cytologie pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.affiliation: 1] Maladies de l'appareil digestif et de la Nutrition, Pôle médico-chirurgical Huriez, Lille, France [2] Université Lille 2, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.affiliation: 1] Unité de Transplantation hépatique, Pôle Digestif, CHU Saint-Eloi, Montpellier, France [2] Université Montpellier I, Montpellier, France.
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
mesh_terms: D000328:Adult; D000367:Age Factors; D064829:Alcohol Abstinence; D000437:Alcoholism / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors