Liver Transplantation in Patients With Alcoholic Liver Disease

A Retrospective Study

Gabriele A. Vassallo; Claudia Tarli; Maria M. Rando; Carolina Mosoni; Antonio Mirijello; Adwoa Agyei-Nkansah; Mariangela Antonelli; Luisa Sestito; Germano Perotti; Daniela Di Giuda; Salvatore Agnes; Antonio Grieco; Antonio Gasbarrini; Giovanni Addolorato

Disclosures

Alcohol Alcohol. 2018;53(2):151-156. 

In This Article

Results

Statistical analysis included 62 patients transplanted for alcoholic cirrhosis and 92 for viral cirrhosis.

Among patients transplanted for alcoholic cirrhosis 51 (82%) were males and 11 (18%) were females, the mean age was 51.4 years; the mean Body Mass Index was 27.5 kg/m2, 15 (24%) patients presented with diabetes mellitus before transplantation, 12 (19%) reported alcohol relapse after transplantation, 42 (68%) used tobacco before transplantation and 18 (29%) used tobacco after transplantation.

Among patients transplanted for viral cirrhosis 68 (74%) were males, 24 (26%) were females, the mean age was 50.2 years; the mean BMI was 25.8 kg/m2, 17 (18%) patients presented with diabetes mellitus prior to transplantation, 35 (32%) used tobacco before transplantation and 25 (27%) used tobacco after transplantation.

The two patients group did not significantly differ in age, gender distribution and post-transplant smoking habits. Conversely, the number of patients with smoking habits before transplantation, the Body Mass Index, the MELD and Child-Pugh scores were significantly higher in the group of patients transplanted for alcoholic cirrhosis (P = 0.0003, P = 0.0142, P < 0.0001 and P = 0.02, respectively). Complete sociodemographic and clinical features of patients are as shown in Table 1.

In the group of patients transplanted for alcoholic cirrhosis 17 (27%) patients died and nobody was lost at follow-up, while 30 (33%) died and 3 (3%) were lost at follow-up in the group of patients transplanted for viral cirrhosis. The post-transplant clinical data are reported in Table 2.

Patient survival at 50, 100, 150, 200 and 250 months from first transplantation was, respectively, 81.6%, 68.1%, 61%, 61%, 61%, for patients transplanted for alcoholic cirrhosis, whereas 69.4%, 65.6%, 62.8%, 60.1%, 53%, for those transplanted for viral cirrhosis. Patients transplanted for alcoholic cirrhosis showed a higher survival rate, although not statistically significant (Log Rank P = 0.45), in comparison with the other group of patients. Kaplan–Meier analysis result is shown in Figure 1.

Figure 1.

Kaplan–Meier survival analysis of patients transplanted for ALD and viral cirrhosis (VIR). Log Rank P = 0.45.

There was no recurrence of primary liver disease after LT among the transplanted alcoholic cirrhosis cohort compared to the 36 (39%) patients transplanted for viral cirrhosis (P < 0.0001).

In the group of patients transplanted for alcoholic cirrhosis 2 (3%) were re-transplanted, while in the group of patients with viral cirrhosis 5 (5%) were re-transplanted. The causes of re-transplantation are reported in Table 3.

In the group of patients transplanted for alcoholic cirrhosis 11 (18%) developed acute rejection, 17 (27%) de novo cancer, 9 (15%) hepatic artery stenosis/thrombosis, 23 (37%) infection, 12 (19%) metabolic complications, 4 (6%) cardiovascular disease and 6 (10%) cerebrovascular disease. In the group of patients transplanted for viral cirrhosis 23 (25%) developed acute rejection, 11 (12%) de novo cancer, 10 (11%) hepatic artery stenosis/thrombosis, 28 (30%) infection, 12 (13%) metabolic complications, 8 (9%) cardiovascular disease and 5 (5%) cerebrovascular disease. The data about post-transplant complications are as shown in Table 4. No significant statistically difference was found in terms of the prevalence of these complications between these two groups, except for the prevalence of de novo cancer that was higher in the group of patients transplanted for alcoholic cirrhosis than those transplanted for viral cirrhosis (P = 0.015). The types of de novo cancer in both groups are reported in Table 5.

Among those transplanted for alcoholic cirrhosis, 7 (41%) died from de novo cancer, while 3 (10%) patients died from the same cause among the viral cirrhotic patients that were transplanted.

In the group of patients transplanted for alcoholic cirrhosis logistic regression analyses showed a negative correlation between onset of de novo cancer and MELD score (P = 0.0078) and a positive correlation with the use of tobacco after LT (P < 0.0001).

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