People who consume alcohol after a liver transplant tend to face worse survival odds compared to those who abstain after such a procedure, says a new, long-term study. And the negative impact of alcohol begins to be felt about a decade after surgery, the study authors found.1
The odds of survival after liver transplantation up to 7 years later are reportedly similar between alcoholics and nonalcoholics—approximately 60%, wrote Antonio Cuadrado, MD, of the Gastroenterology and Hepatology Unit of the University Hospital "Marques de Valdecilla" in Santander, Spain, and his fellow researchers. Thus, alcoholic liver disease appears to be a good indication for liver transplantation. The disease is the leading cause of cirrhosis and the second most common reason for liver transplantation, according to the authors.
Nagging Controversy
"Nonetheless, this indication still remains controversial, based partly on concerns regarding alcohol relapse and functional outcome after transplantation in an era of donor organ shortage and priority setting," Cuadrado and his colleagues pointed out.
In fact, they write, it is common practice to establish a period of abstinence from alcohol at least 6 months before a patient with alcoholic liver disease is listed for liver transplant. This practice not only stabilizes or potentially improves the recipient's liver function, but also potentially lowers the odds that the recipient will begin consuming alcohol again after the procedure.
Additionally, a person is more likely to experience alcoholic relapse if he or she abstains for less than 6 months, the researchers stated.
While previous studies had examined the odds of patient survival in the context of alcoholic relapse after liver transplant, Cuadrado's team wanted to follow a larger group of patients for a longer period to determine if there really was an impact.
Follow-Up Analysis
The research expanded on a 1977 analysis involving 44 patients who had undergone liver transplants for alcoholic liver disease, comparing their outcomes with a group of patients who underwent liver transplants for other reasons. This study was then enlarged to include 10 additional patients, including those analyzed in the previous study. Each patient was followed, on average, for a period of more than 99 months. They were asked to abstain from alcohol for at least 6 months prior to their transplant procedure.
Each patient was also given the same immunosuppressive treatment, consisting of cyclosporine A, steroids, and azathioprine.
During follow-up, patients were questioned about alcohol consumption, compliance with their immunosuppressive regimen, and their health status. The patients also underwent a range of tests, including routine liver biopsies to assess the condition of the livers postoperatively.
Alcohol Relapse Noted
After their transplants, 14 patients in this study began consuming alcohol again. None of these patients experienced any significant medical complications as a result, and there were no differences in postoperative liver function between these patients and those who did not have alcoholic relapse. None of the patients experienced acute rejection due to poor compliance with immunosuppressive medications, as well.
Cuadrado and his team also found that survival odds were generally about the same between those who began alcohol consumption after liver transplant and those who didn't, but differences began cropping up at the 10-year mark.
Differences in Survival Odds Found
Those who were consuming alcohol again faced about a 45% survival rate 10 years after their surgery compared to approximately 85% survival odds for those who weren't consuming alcohol afterwards. "This unexpected finding could be explained by the higher mortality rate in the first group, mainly because of cancer and different cardiovascular events," the study investigators stated. It's well known that alcohol is linked with an increased risk for several types of cancer, they explained.2
Those who were alcohol relapsers also tended to continue smoking after surgery, which would also explain their higher risk of developing cancer, Cuadrado's group added.
"In conclusion, we observed a significant decline in 10-year survival rates in patients who underwent transplantation for alcoholic liver disease who relapsed into alcohol use compared with those who remained abstinent," the authors wrote. "These findings do not appear to be related to the graft evolution, rejections, infections, or metabolic disturbances, but a higher incidence of malignancies and cardiovascular events appears to underlie this higher mortality."
These patients should be followed more closely and carefully after liver transplantation, they said. Risk reducing measures should be encouraged for them, as well, such as halting their consumption of alcohol and smoking habit.
1. Cuadrado A, Fabrega E, Casafout F, Pons-Romero F. Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl 2005 Mar 17;11(4):420-6. [Epub ahead of print].
2. Saigal S, Norris S, Muiesan P, Rela M, Heaton N, O'Grady J. Evidence of differential risk for posttransplantation malignancy based on pretransplantation cause in patients undergoing liver transplantation. Liver Transpl 2002;8:482-7.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
