title: Good outcome after liver transplantation for ALD without a 6 months abstinence rule prior to transplantation including post-transplant CDT monitoring for alcohol relapse assessment - a retrospective study.
abstract: Alcoholic liver disease (ALD) is the second most common indication for liver transplantation (LT). The utility of fixed intervals of abstinence prior to listing is still a matter of discussion. Furthermore, post-LT long-term observation is challenging, and biomarkers as carbohydrate-deficient transferrin (CDT) may help to identify alcohol relapse. We retrospectively analyzed data from patients receiving LT for ALD from 1996 to 2012. A defined period of alcohol abstinence prior to listing was not a precondition, and abstinence was evaluated using structured psychological interviews. A total of 382 patients received LT for ALD as main (n = 290) or secondary (n = 92) indication; median follow-up was 73 months (0-213). One- and five-year patient survival and graft survival rates were 82% and 69%, and 80% and 67%, respectively. A total of 62 patients (16%) experienced alcohol relapse. Alcohol relapse did not have a statistically significant effect on patient survival (P = 0.10). Post-transplant CDT measurements showed a sensitivity and specificity of 84% and 85%, respectively. In conclusion, this large single-center analysis showed good post-transplant long-term results in patients with ALD when applying structured psychological interviews before listing. Relapse rates were lower than those reported in the literature despite using a strict definition of alcohol relapse. Furthermore, post-LT CDT measurement proved to be a useful supplementary tool for detecting alcohol relapse.
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Dagmar
authors: D
authors: Kollmann
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.|Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria.
authors: Susanne
authors: S
authors: Rasoul-Rockenschaub
authors: Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria.
authors: Irene
authors: I
authors: Steiner
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Edith
authors: E
authors: Freundorfer
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Georg Philipp
authors: GP
authors: Györi
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Gerd
authors: G
authors: Silberhumer
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Thomas
authors: T
authors: Soliman
authors: Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
authors: Gabriela Andrea
authors: GA
authors: Berlakovich
mesh_terms: D064829:Alcohol Abstinence; D000428:Alcohol Drinking; D015415:Biomarkers; D002241:Carbohydrates / Q000737:chemistry; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013997:Time Factors; D014168:Transferrin / Q000031:analogs & derivatives / Q000737:chemistry / Q000627:therapeutic use; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D015415:Biomarkers; D002241:Carbohydrates; D014168:Transferrin; C056759:carbohydrate-deficient transferrin
keywords: alcohol relapse; alcoholic liver disease; carbohydrate deficient transferrin; liver transplantation