Alcohol Consumption After Listing for Liver Transplantation Is Associated With Increased Risk of Alcohol Consumption After Transplantation.

Abstract

Background: Alcohol abstinence is required before liver transplantation (LT) for alcohol-related liver disease (ALD). However, some patients may have alcohol intake during the pretransplant period. Objectives: Describe the prevalence of alcohol consumption on list and impact on the LT project. Methods: All patients listed for ALD, in two French transplant centers, between January 2014 and December 2018 were included retrospectively. Documented alcohol consumption (DAC) on list was defined by any alcohol intake during the waiting period elicited by patient interview and/or by biology. Results: Four hundred and twenty-six patients were included. DAC on list was observed in 41 patients (9.6%), with a median delay of 6.2 months (IQR 2.8; 11.4) after listing. Addiction counseling was proposed to 30 patients (73%), and 28 (68%) were placed or maintained in temporary contraindication. DAC on list was associated with the waiting time length (OR 1.07, 95% CI 1.04; 1.1; p < 0.001), occupation ("intermediate occupation" OR 6.39, 95% CI 1.93; 22.74, p = 0.003 and "employee": OR 5.83, 95% CI 1.79; 20.68, p = 0.004 compared to "Craftsman" category) and less likely in former smokers (OR 0.23, 95% CI 0.07; 0.77; p = 0.02). We observed a higher risk of alcohol consumption after LT (OR 6.36, 95% CI 1.61-26.93; p = 0.009) in patient with DAC on list, but no impact on 5-year posttransplant survival. Conclusion: Alcohol consumption on the list was documented in 9.6% of the patients, associated with an increased risk of alcohol consumption after LT. These results support systematic screening of alcohol consumption and active addiction counseling before transplant. Importantly, 5-year overall survival since listing was not statistically different between patients with or without DAC during the waiting time period.