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Liver Transplantation for Alcohol-Related Cirrhosis: A Single Centre Long-Term Clinical and Histological Follow-Up

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Abstract

Background

Alcohol-induced liver cirrhosis is one of the leading indications for liver transplantation today. Due to the general organ shortage and continuous deaths on the waiting list there has been some debate on the issue of indication and ethical problems. It was the aim of this study to critically analyse the outcome of patients with alcoholic cirrhosis transplanted at our centre with special emphasis on alcohol-recurrence frequency and long-term histological follow-up.

Methods

Three hundred five patients who received LT for alcoholic cirrhosis at our institution were followed over a period of 3–10 years after transplantation. Biopsies were taken 1, 3, 5, and 10 years after LT. Specimens were analysed and staged concerning inflammation, rejection, fatty involution, and fibrosis/cirrhosis. Clinical characteristics as well as serological parameters, immunosuppressive protocols, rejection episodes, and patient and graft survival were recorded.

Results

Recurrence of alcohol abuse occurred in 27% of all patients analysed. Regardless of alcohol consumption, 5-year graft and patient survival were excellent; after 10 years abstinent patients showed significantly better survival (82% vs. 68%; P = 0.017). Histological changes were slightly more pronounced among recurrent drinkers, no significant difference regarding inflammation or fibrosis was detected.

Conclusion

Patients undergoing LT for alcohol-induced cirrhosis show excellent long-term survival rates with stable graft function. Alcohol recurrence impairs long-term prognosis; however, compared to other patient sub-populations (HCC, HCV) results are clearly above average.

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Abbreviations

LT:

Liver transplantation

ALD:

Alcoholic liver disease

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C

HBV:

Hepatitis B

CNI:

Calcineurin inhibitors

CyA:

Cyclosporine A

Tac:

Tacrolimus

AST:

Aspartate amino transferase

ALT:

Alanine amino transferase

GGT:

Gamma glutamyl transferase

AP:

Alkaline phosphatase

GLDH:

Glutamate dehydrogenase

INR:

International standard normalized ratio

MELD:

Model of end stage liver disease

References

  1. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: A disease-specific analysis of the UNOS database. Liver Transpl. 2004;10:886–897.

    Article  PubMed  Google Scholar 

  2. Yao FY, Saab S, Bass NM, et al. Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores. Hepatology. 2004;39:230–238.

    Article  PubMed  Google Scholar 

  3. Mutimer DJ, Gunson B, Chen J, et al. Impact of donor age and year of transplantation on graft and patient survival following liver transplantation for hepatitis C virus. Transplantation. 2006;81:7–14.

    Article  PubMed  Google Scholar 

  4. Neuberger J, Adams D, MacMaster P, Maidment A, Speed M. Assessing priorities for allocation of donor liver grafts: Survey of public and clinicians. BMJ. 1998;317:172–175.

    CAS  PubMed  Google Scholar 

  5. Dixon J, Welch HG. Priority setting: Lessons from Oregon. Lancet. 1991;337:891–894.

    Article  CAS  PubMed  Google Scholar 

  6. Mandayam S, Jamal MM, Morgan TR. Epidemiology of alcoholic liver disease. Semin Liver Dis. 2004;24:217–232.

    Article  PubMed  Google Scholar 

  7. Lim JK, Keeffe EB. Liver transplantation for alcoholic liver disease: Current concepts and length of sobriety. Liver Transpl. 2004;10:S31–S38.

    Article  PubMed  Google Scholar 

  8. Berlakovich GA. Wasting your organ with your lifestyle and receiving a new one? Ann Transplant. 2005;10:38–43.

    PubMed  Google Scholar 

  9. O’Grady JG. Liver transplantation alcohol related liver disease: (deliberately) stirring a hornet’s nest! Gut. 2006;55:1529–1531.

    Article  PubMed  Google Scholar 

  10. Miguet M, Monnet E, Vanlemmens C, et al. Predictive factors of alcohol relapse after orthotopic liver transplantation for alcoholic liver disease. Gastroenterol Clin Biol. 2004;28:845–851.

    Article  PubMed  Google Scholar 

  11. Perney P, Bismuth M, Sigaud H, et al. Are preoperative patterns of alcohol consumption predictive of relapse after liver transplantation for alcoholic liver disease? Transpl Int. 2005;18:1292–1297.

    Article  PubMed  Google Scholar 

  12. Tome S, Martinez-Rey C, Gonzalez-Quintela A, et al. Influence of superimposed alcoholic hepatitis on the outcome of liver transplantation for end-stage alcoholic liver disease. J Hepatol. 2002;36:793–798.

    Article  PubMed  Google Scholar 

  13. Bjornsson E, Olsson J, Rydell A, et al. Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden: Impact of structured management on recidivism. Scand J Gastroenterol. 2005;40:206–216.

    Article  PubMed  Google Scholar 

  14. Bahra M, Neumann UP, Jacob D, et al. Outcome after liver re-transplantation in patients with recurrent chronic hepatitis C. Transpl Int. 2007;20:771–778.

    Article  PubMed  Google Scholar 

  15. Berenguer M, Prieto M, Palau A, et al. Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis. Liver Transpl. 2003;9:228–235.

    Article  PubMed  Google Scholar 

  16. Neumann UP, Berg T, Bahra M, et al. Long-term outcome of liver transplants for chronic hepatitis C: A 10-year follow-up. Transplantation. 2004;77:226–231.

    Article  PubMed  Google Scholar 

  17. Pfitzmann R, Schwenzer J, Rayes N, Seehofer D, Neuhaus R, Nussler NC. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl. 2007;13:197–205.

    Article  PubMed  Google Scholar 

  18. Pageaux GP, Bismuth M, Perney P, et al. Alcohol relapse after liver transplantation for alcoholic liver disease: Does it matter? J Hepatol. 2003;38:629–634.

    Article  CAS  PubMed  Google Scholar 

  19. Cescon M, Grazi GL, Ercolani G, et al. Long-term survival of recipients of liver grafts from donors older than 80 years: Is it achievable? Liver Transpl. 2003;9:1174–1180.

    Article  PubMed  Google Scholar 

  20. Nardo B, Masetti M, Urbani L, et al. Liver transplantation from donors aged 80 years and over: Pushing the limit. Am J Transplant. 2004;4:1139–1147.

    Article  PubMed  Google Scholar 

  21. Nardo B, Montalti R, Beltempo P, et al. Octogenarian livers successfully transplanted in patients with fulminant hepatic failure. Transplant Proc. 2005;37:389–391.

    Article  CAS  PubMed  Google Scholar 

  22. Gastaca M, Valdivieso A, Pijoan J, et al. Donors older than 70 years in liver transplantation. Transplant Proc. 2005;37:3851–3854.

    Article  CAS  PubMed  Google Scholar 

  23. Zapletal C, Faust D, Wullstein C, et al. Does the liver ever age? Results of liver transplantation with donors above 80 years of age. Transplant Proc. 2005;37:1182–1185.

    Article  PubMed  Google Scholar 

  24. Busuttil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver Transpl. 2003;9:651–663.

    Article  PubMed  Google Scholar 

  25. Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: The concept of a donor risk index. Am J Transplant. 2006;6:783–790.

    Article  CAS  PubMed  Google Scholar 

  26. Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM. The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality. Am J Transplant. 2008;8(2):419–425.

    Google Scholar 

  27. Busquets J, Xiol X, Figueras J, et al. The impact of donor age on liver transplantation: Influence of donor age on early liver function and on subsequent patient and graft survival. Transplantation. 2001;71:1765–1771.

    Article  CAS  PubMed  Google Scholar 

  28. Rifai K, Sebagh M, Karam V, et al. Donor age influences 10-year liver graft histology independently of hepatitis C virus infection. J Hepatol. 2004;41:446–453.

    Article  PubMed  Google Scholar 

  29. Roayaie K, Feng S. Allocation policy for hepatocellular carcinoma in the MELD era: Room for improvement? Liver Transpl. 2007;13:S36–S43.

    Article  PubMed  Google Scholar 

  30. Piscaglia F, Camaggi V, Ravaioli M, et al. A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system. Liver Transpl. 2007;13:857–866.

    Article  PubMed  Google Scholar 

  31. Fisher RA, Kulik LM, Freise CE, et al. Hepatocellular carcinoma recurrence and death following living and deceased donor liver transplantation. Am J Transplant. 2007;7:1601–1608.

    Article  CAS  PubMed  Google Scholar 

  32. Amin MG, Wolf MP, TenBrook JA Jr, et al. Expanded criteria donor grafts for deceased donor liver transplantation under the MELD system: A decision analysis. Liver Transpl. 2004;10:1468–1475.

    Article  PubMed  Google Scholar 

  33. Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transplant. 2005;5:307–313.

    Article  PubMed  Google Scholar 

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Author notes

  1. M. Schmeding & U. P. Neumann

    Present address: Department of General, Visceral and Transplantation Surgery, University of Aachen RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany

Authors and Affiliations

  1. Department of General and Transplantation Surgery, Charité University Hospital, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany

    M. Schmeding, C. Heidenhain, R. Neuhaus, P. Neuhaus & U. P. Neumann

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  1. M. Schmeding
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  2. C. Heidenhain
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  3. R. Neuhaus
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  4. P. Neuhaus
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  5. U. P. Neumann
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Correspondence to M. Schmeding.

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Schmeding, M., Heidenhain, C., Neuhaus, R. et al. Liver Transplantation for Alcohol-Related Cirrhosis: A Single Centre Long-Term Clinical and Histological Follow-Up. Dig Dis Sci 56, 236–243 (2011). https://doi.org/10.1007/s10620-010-1281-7

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  • DOI: https://doi.org/10.1007/s10620-010-1281-7

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