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World J Hepatol. Jun 18, 2017; 9(17): 771-780
Published online Jun 18, 2017. doi: 10.4254/wjh.v9.i17.771
Risk factors and outcomes associated with alcohol relapse after liver transplantation
Jane Lim, Michael P Curry, Vinay Sundaram
Jane Lim, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
Michael P Curry, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Vinay Sundaram, Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Author contributions: Lim J wrote the manuscript and generated the tables; Sundaram V designed the aim of the article and contributed to the writing and editing; Curry MP provided guidance on the aim of the article and contributed to editing.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other coauthors who contributed their efforts in this manuscript.
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: Vinay Sundaram, MD, MSc, Assistant Medical Director, Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, 8900 Beverly Blvd, Suite 250, Los Angeles, CA 90048, United States. vinay.sundaram@cshs.org
Telephone: +1-310-4236000 Fax: +1-310-4230849
Received: December 27, 2016
Peer-review started: December 27, 2016
First decision: February 4, 2017
Revised: March 7, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: June 18, 2017
Abstract

Alcoholic liver disease (ALD) is the second most common indication for liver transplantation (LT) in the United States and Europe. Unlike other indications for LT, transplantation for ALD may be controversial due to the concern for alcohol relapse and non-compliance after LT. However, the overall survival in patients transplanted for ALD is comparable or higher than in patients transplanted for other etiologies of liver disease. While the rate of alcohol use after liver transplantation does not differ among various etiologies of liver disease, alcohol relapse after transplantation for ALD has been associated with complications such as graft rejection, graft loss, recurrent alcoholic cirrhosis and reduced long-term patient survival. Given these potential complications, our review aimed to discuss risk factors associated with alcohol relapse and the efficacy of various interventions attempted to reduce the risk of alcohol relapse. We also describe the impact of alcohol relapse on post-transplant outcomes including graft and patient survival. Overall, alcohol liver disease remains an appropriate indication for liver transplantation, and long-term mortality in this group of patients is primarily attributed to cardiovascular disease or de novo malignancies rather than alcohol related hepatic complications, among those who relapse.

Keywords: Cirrhosis, Relapse prevention, Recidivism

Core tip: There are no established risk factors or scoring systems to predict alcohol relapse after transplantation for alcoholic liver disease. Studies regarding the “6-mo rule” demonstrated heterogeneous findings, suggesting that this rule is not a reliable predictor of relapse. Comorbid psychiatric conditions, lack of social support, and tobacco use are consistently associated with alcohol relapse. Scoring systems have been proposed, but have not been validated. Alcohol relapse may be associated with graft rejection and graft loss, though reduction in long-term survival may be attributed to cardiovascular disease and de-novo malignancies rather than alcohol-related hepatic complications.