title: Epidemiology, Evolution, and Long-Term Survival of Alcoholic Cirrhosis Patients Submitted to Liver Transplantation in Southeastern Spain.
abstract: BACKGROUND
  Alcoholic cirrhosis (AC) is a common cause of death among individuals abusing alcohol. In the last resort, liver transplantation (LT) is considered the only solution to save the patient's life, generating socioeconomic and public health problems. Clinical and sociodemographic characteristics, rejection frequency, and short- and long-term graft survival are not well known in end-term AC patients undergoing LT. The aim was to determine the sociodemographic and clinical characteristics, their incidence in LT, main pre- and posttransplant complications, and short- and long-term post-transplant graft survival in AC patients in southeastern Spain.
  
  
  METHODS
  The medical records of 1,026 patients who underwent LT over the last 23 years were retrospectively reviewed, and demographic data and posttransplant survivals were analyzed and compared. Biochemical characteristics, major pre- and posttransplant complications and short- and long-term survivals were analyzed in a total of 398 male patients with AC undergoing LT.
  
  
  RESULTS
  AC and viral cirrhosis are the main indications for LT in our study. Mostly represented in our study are AC men without associated viral infections with a mean age of 53.06 years. Main pretransplant complications in AC patients are ascites (78.3%) and encephalopathy (43.5%), while acute graft rejection is the most common liver posttransplant complication (26.6%), nevertheless with low graft loss frequency (1.1%). AC and autoimmune cirrhosis show the best posttransplant survival in both the short and long term. Patients with AC included on the waiting list for LT were Child-Pugh class B (52.1%) and Model for End-Stage Liver Disease score of 10 to 19 (71.2%). The highest percentage of AC patient survival was observed at 1 year posttransplant (81.2%) and progressively decreased over time up to 10 years posttransplant (69.6%). Pretransplant complications such as ascites and encephalopathy did not have an influence on the percentage of posttransplant survivals, although better survival rates were observed in nonviral AC patients.
  
  
  CONCLUSIONS
  AC without viral infections is the main indication for LT in southeastern Spain although its frequency has decreased in last decade. AC is a good indication for LT for its high survival rate and few posttransplant complications. Despite having a high percentage of pretransplant complications (ascites and encephalopathy) but does not appear to influence survivals being observed posttransplant survival rates above those expected. Conversely, viral infections in the patient with AC decrease patient survivals. The main future goals are design new strategies to detect, treat, and reduce AC frequency in our population and know alcoholic recidivism rate posttransplant in our population.
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.|Department of Legal and Forensic Medicine , University of Murcia, Murcia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Legaz
authors.affiliation: Digestive Medicine Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Navarro-Noguera
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Bolarín
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: García-Alonso
authors.affiliation: Department of Legal and Forensic Medicine , University of Murcia, Murcia, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Luna Maldonado
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mrowiec
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Campillo
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Gimeno
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Moya-Quiles
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Maria Del Rocio
authors.initials: Mdel R
authors.lastname: Álvarez-López
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Minguela Puras
authors.affiliation: Digestive Medicine Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Miras
authors.affiliation: Digestive Medicine Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sánchez-Bueno
authors.affiliation: Immunology Service , Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muro
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality* / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
keywords: Alcohol; Alcoholic Cirrhosis; Child-Pugh; Liver Rejection; Liver Transplant; Model for End-Stage Liver Disease; Survival