Liver Transplants & Patients with Alcoholism
Liver transplant recipients with a history of alcoholism are much less likely to start drinking again if they undergo substance-abuse treatment before and after their transplant, new research finds. And a second study shows that continued alcohol abuse after a liver transplant raises the risk of transplant failure. Both studies were published in the October 2013 issue of the journal Liver Transplantation. Alcoholic liver disease (ALD) is the second most common reason for liver transplants in the United States and Europe, but research suggests that anywhere from 10 percent to 90 percent of ALD patients who get a new liver start drinking again after their transplant.
The liver is the organ responsible for metabolizing alcohol, hence its fragile vulnerability to alcohol abuse. While some liver conditions are hereditary and unrelated to alcohol or drug abuse, alcohol abuse is strongly associated with liver disease, as it causes hepatitis, cirrhosis, chronic alcoholic and end-stage liver disease, and liver failure. Patients in need of a liver transplant must be prioritized on the waiting list, and while the basic criteria (urgency, chance of success and future health) are universal, each medical organization may apply its own screening method for “numbering” patients. Active alcohol abuse or abstinence from alcohol affects a patient.
Alcohol can cause lethal, liver-destroying diseases such as cirrhosis and hepatitis. Nearly one in five liver transplants in the U.S. go to current or former heavy drinkers. Transplant hospitals commonly require patients waiting for a new liver to give up drinking for six months as a way of assuring doctors they are serious about staying sober after the operation.Drinkers severely ill with hepatitis account for a very small share of patients needing transplants. A French study suggests that dropping the six-month rule for these patients would increase demand for livers by only about 3 percent,keeping the rule for other alcoholics with liver disease, noting that some can recover liver function simply by staying sober.
The relapse rates were 41 percent for those who received substance-abuse treatment before their transplant and 45 percent for those who received no substance-abuse treatment, according to James Rodrigue, of The Transplant Institute at Beth Israel Deaconess Medical Center in Boston. “While many transplant centers require candidates with a history of alcohol abuse to attend substance-abuse treatment prior to transplantation, our findings emphasize the importance of continued therapy after the transplant to prevent alcohol relapse.” The second study found that patients with alcoholic liver disease who resumed excessive drinking after a liver transplant were more likely to experience liver scarring and transplant failure.
Studies highlights the need for ongoing assessments of alcohol use as part of post-transplant care. Given the shortage of available donor livers, maintaining sobriety is critical to maximizing organ use and patient outcomes following transplantation. Dr. John Rice, from the University of Wisconsin School of Medicine and Public Health, said in a recent news release. An important determinant of success is that clinicians caring for patients with end-stage alcoholic liver disease consider transplantation as a potential option and refer their patients early to a transplant center for evaluation. With progressively increasing waiting times until donor organs become available, delayed referral may prevent the patient from surviving the evaluation and waiting period.