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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2015; 21(39): 11027-11033
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11027
Candidates for liver transplantation with alcoholic liver disease: Psychosocial aspects
Diogo Telles-Correia, Inês Mega
Diogo Telles-Correia, Deparment of Psychiatry, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
Diogo Telles-Correia, Inês Mega, Curry Cabral Liver Transplantation Center, 1649-028 Lisbon, Portugal
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest statement: The authors have no conflicts of interest on this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Diogo Telles-Correia, MD, PhD, Professor, Deparment of Psychiatry, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. tellesdiogo@gmail.com
Telephone: +1-51-49341934 Fax: +1-51-48431434
Received: April 1, 2015
Peer-review started: April 2, 2015
First decision: June 2, 2015
Revised: June 23, 2015
Accepted: August 30, 2015
Article in press: August 30, 2015
Published online: October 21, 2015
Abstract

In Europe, 30% to 50% of liver transplantations are currently due to alcoholic liver disease (ALD). In the United States, this percentage is 17.2%. Post-transplant survival and other predictors of clinical course do not differ significantly from those in other types of transplanted patients, as long as there is no relapse of drinking. However, 20%-25% of these patients lapse or relapse to heavy drinking post-operatively, which has been associated with an increased risk of liver damage and mortality. It is therefore crucial to design specific selection and follow-up strategies aimed at this particular type of patient. Several good and poor prognosis factors that could help to predict a relapse have been suggested, among them the duration of abstinence, social support, a family history of alcoholism, abuse diagnosis versus alcohol dependence, non-acceptance of diagnosis related to alcohol use, presence of severe mental illness, non-adherence in a broad sense, number of years of alcoholism, and daily quantity of alcohol consumption. In this article, we discuss these and other, more controversial factors in selecting ALD patients for liver transplantation. Abstinence should be the main goal after transplantation in an ALD patient. In this article, we review the several definitions of post-transplant relapse, its monitoring and the psychopharmacological and psychotherapeutic treatment.

Keywords: Liver transplantation, Alcoholic liver disease, Psychosocial assessment, Psychosocial selection

Core tip: Currently, alcoholic liver disease (ALD) is one of the most common indications for liver transplant, and post-transplantation survival and other predictors of clinical course in ALD patients do not differ significantly from other types of transplanted patients, as long as there is no relapse of drinking. It is crucial to design specific selection and follow-up strategies aimed at this particular type of patient. In this article, we discuss several factors that are important to consider in the selection and follow-up of liver transplanted ALD patients.