The Case of the Soldier-Statesman With a Bloated Belly

Albert B. Lowenfels, MD


March 08, 2012

How Would This Patient Be Treated Today?

It is surprising that Atatürk's disease was discovered at such a late stage, when treatment options were limited. Advanced cirrhosis with coagulation abnormalities and portal hypertension was finally diagnosed only when Atatürk developed nosebleeds and ascites. The delay in diagnosis may have been due not to ignorance but instead to the delicate nature of having to tell Atatürk, and also the Turkish nation, that a widely respected Muslim leader had a serious alcohol-related disease.

Atatürk's cirrhosis was diagnosed in the 1930s; percutaneous liver biopsy had been available as a diagnostic tool since 1923,[3] however, and an accurate diagnosis of the underlying illness could have been obtained much earlier. With earlier recognition of the underlying alcohol problem, counseling might have convinced Atatürk to become abstinent (although the overall success rate of this strategy is low).

At the time of Atatürk's illness, nobody anticipated that liver transplantation would become an effective option for patients with liver failure. Although successful kidney transplant had been done using an identical twin as a donor in 1954, the first liver transplant took place in 1967 -- a decade later.[4] Early results were disappointing, and 1-year survival rates were only about 25%. Now, with the use of immunosuppressive agents, about three quarters of patients survive for 5 years.[5,6]

At present, about one third of all liver transplants in Europe are performed in patients with a diagnosis of alcoholic cirrhosis, and the listed 5-year survival rate is 73%. These rates closely resemble the recently reported results for the United States.[7]

We do not have Atatürk's laboratory test results to calculate a Model for End-Stage Liver Disease score, so it is uncertain whether liver transplant would have been an option for this patient. Turkey now has an active transplant program and provides data to the European Transplant Registry. Turkey is one of the top 17 countries with respect to publication on liver transplant.[8]

Abstinence for about 6 months has traditionally been a major criterion for determining the suitability of patients with alcoholic cirrhosis for liver transplant. However, a recent study shows that in some alcoholic patients for whom the probability of death from liver failure is high, overall survival can be improved even if this requirement is waived.[9]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.