Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2016; 22(20): 4789-4793
Published online May 28, 2016. doi: 10.3748/wjg.v22.i20.4789
When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?
Monica Leon, Joseph Varon, Salim Surani
Monica Leon, Facultad de Medicina, Universidad Popular Autonoma del Estado de Puebla, Puebla, Puebla 72410, Mexico
Joseph Varon, Foundation Surgical Hospital of Houston, Houston, TX 77054, United States
Salim Surani, Texas A and M University, Corpus Christi, TX 78405, United States
Salim Surani, Pulmonary Associates, Corpus Christi, TX 78336, United States
Author contributions: All authors have contributed in preparation and review of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
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: Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM, Texas A and M University, 1177 West Wheeler, Avenue, Aransas Pass Texas, Corpus Christi, TX 78405, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: February 9, 2016
Peer-review started: February 9, 2016
First decision: March 21, 2016
Revised: April 2, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: May 28, 2016

Alcoholic liver disease (ALD) is one of the most common indications for liver transplantation (LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a “self-inflicted disease”. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ.

Keywords: Liver transplantation, Alcoholic liver disease, Alcoholic cirrhosis, Selection criteria, Relapses

Core tip: Alcoholic liver disease is one of the most common indications for liver transplantation (LT). The selection criteria of the majority of transplant programs require 6-mo of complete abstinence, with the aim to allow spontaneous liver recovery and to overcome addiction issues. The evaluation of LT candidates should be multidisciplinary with a strong emphasis in family and social support and a strong patient commitment of abstinence to prevent relapses.