Bellamy, COC and DiMartini, AM and Ruppert, K and Jain, A and Dodson, F and Torbenson, M and Starzl, TE and Fung, JJ and Demetris, AJ
(2001)
Liver transplantation for alcoholic cirrhosis: Long term follow-up and impact of disease recurrence.
Transplantation, 72 (4).
619 - 626.
ISSN 0041-1337
Abstract
Background. Alcoholic liver disease has emerged as a leading indication for hepatic transplantation, although it is a controversial use of resources. We aimed to examine all aspects of liver transplantation associated with alcohol abuse. Methods. Retrospective cohort analysis of 123 alcoholic patients with a median of 7 years follow-up at one center. Results. In addition to alcohol, 43 (35%) patients had another possible factor contributing to cirrhosis. Actuarial patient and graft survival rates were, respectively, 84% and 81% (1 year); 72% and 66% (5 years); and 63% and 59% (7 years). After transplantation, 18 patients (15%) manifested 21 noncutaneous de novo malignancies, which is significantly more than controls (P=0.0001); upper aerodigestive squamous carcinomas were over-represented (P=0.03). Thirteen patients had definitely relapsed and three others were suspected to have relapsed. Relapse was predicted by daily ethanol consumption (P=0.0314), but not by duration of pretransplant sobriety or explant histology. No patient had alcoholic hepatitis after transplantation and neither late onset acute nor chronic rejection was significantly increased. Multiple regression analyses for predictors of graft failure identified major biliary/vascular complications (P=0.01), chronic bile duct injury on biopsy (P=0.002), and pericellular fibrosis on biopsy (P=0.05); graft viral hepatitis was marginally significant (P=0.07) on univariate analysis. Conclusions. Alcoholic liver disease is an excellent indication for liver transplantation in those without coexistent conditions. Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure. Potential recipients should be heavily screened before transplantation for coexistent conditions (e.g., hepatitis C, metabolic diseases) and other target-organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease.
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| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Bellamy, COC | | | | | DiMartini, AM | | | | | Ruppert, K | ruppertk@pitt.edu | RUPPERTK | | | Jain, A | | | | | Dodson, F | | | | | Torbenson, M | | | | | Starzl, TE | tes11@pitt.edu | TES11 | | | Fung, JJ | | | | | Demetris, AJ | | | |
|
| Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
| Date: |
27 August 2001 |
| Date Type: |
Publication |
| Journal or Publication Title: |
Transplantation |
| Volume: |
72 |
| Number: |
4 |
| Page Range: |
619 - 626 |
| DOI or Unique Handle: |
10.1097/00007890-200108270-00010 |
| Institution: |
University of Pittsburgh |
| Refereed: |
Yes |
| ISSN: |
0041-1337 |
| Other ID: |
uls-drl:31735062120559, Starzl CV No. 2145 |
| Date Deposited: |
08 Apr 2010 17:36 |
| Last Modified: |
02 Feb 2019 15:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/5531 |
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