Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11027
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
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.
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.