{"title":"Long-term outcomes of liver transplantation for alcohol-related liver disease.","authors":"Niang-Cheng Lin, Chinsu Liu, Cheng-Yen Chen, Hao-Jan Lei, Yi-Fan Tsou, Fang-Cheng Kuo, Shu-Cheng Chou, Meng-Hsuan Chung, Cheng-Yuan Hsia, Che-Chuan Loong, Shen-Chih Wang, Oscar K Lee, Hsin-Lin Tsai","doi":"10.1097/JCMA.0000000000000940","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) is being increasingly performed for alcohol-related liver disease (ALD). It is unclear whether the increasing frequency of LTs in ALD patients has a negative impact on deceased-donor (DDLT) allocation and whether the current policy of 6 months of abstinence before transplantation effectively prevents recidivism after transplantation or improves long-term outcomes.</p><p><strong>Methods: </strong>A total of 506 adult LT recipients, including 97 ALD patients, were enrolled. The outcomes of ALD patients were compared with those of non-ALD patients. The 97 ALD patients were further divided into group A (6-month abstinence) and group N (nonabstinence) based on the pretransplant alcohol withdrawal period. The incidence of relapsed drinking and the long-term outcomes were compared between the two groups.</p><p><strong>Results: </strong>The prevalence of LT for ALD significantly increased after 2016 (27.0% vs 14.0%; p < 0.01), but the frequency of DDLT for ALD remained unchanged (22.6% vs 34.1%, p = 0.210). After a median follow-up of 56.9 months, patient survival was comparable between the ALD and non-ALD patients (1, 3, and 5 years posttransplant: 87.6%, 84.3%, and 79.5% vs 82.8%, 76.6%, and 72.2%, respectively; p = 0.396). The results were consistent irrespective of the transplant type and disease severity. In ALD patients, 22 of the 70 (31.4%) patients reported relapsed drinking after transplantation, and the prevalence in group A had a higher tendency than that in group N (38.3% vs 17.4%, p = 0.077). Six months of abstinence or nonabstinence did not result in a survival difference, and de novo malignancies were the leading cause of late patient death in ALD patients.</p><p><strong>Conclusion: </strong>LT achieves favorable outcomes for ALD patients. Six months of abstinence pretransplant did not predict the risk of recidivism after transplantation. The high incidence of de novo malignancies in these patients warrants a more comprehensive physical evaluation and better lifestyle modifications to improve long-term outcomes.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":"86 8","pages":"748-755"},"PeriodicalIF":1.9000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Chinese Medical Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JCMA.0000000000000940","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Liver transplantation (LT) is being increasingly performed for alcohol-related liver disease (ALD). It is unclear whether the increasing frequency of LTs in ALD patients has a negative impact on deceased-donor (DDLT) allocation and whether the current policy of 6 months of abstinence before transplantation effectively prevents recidivism after transplantation or improves long-term outcomes.
Methods: A total of 506 adult LT recipients, including 97 ALD patients, were enrolled. The outcomes of ALD patients were compared with those of non-ALD patients. The 97 ALD patients were further divided into group A (6-month abstinence) and group N (nonabstinence) based on the pretransplant alcohol withdrawal period. The incidence of relapsed drinking and the long-term outcomes were compared between the two groups.
Results: The prevalence of LT for ALD significantly increased after 2016 (27.0% vs 14.0%; p < 0.01), but the frequency of DDLT for ALD remained unchanged (22.6% vs 34.1%, p = 0.210). After a median follow-up of 56.9 months, patient survival was comparable between the ALD and non-ALD patients (1, 3, and 5 years posttransplant: 87.6%, 84.3%, and 79.5% vs 82.8%, 76.6%, and 72.2%, respectively; p = 0.396). The results were consistent irrespective of the transplant type and disease severity. In ALD patients, 22 of the 70 (31.4%) patients reported relapsed drinking after transplantation, and the prevalence in group A had a higher tendency than that in group N (38.3% vs 17.4%, p = 0.077). Six months of abstinence or nonabstinence did not result in a survival difference, and de novo malignancies were the leading cause of late patient death in ALD patients.
Conclusion: LT achieves favorable outcomes for ALD patients. Six months of abstinence pretransplant did not predict the risk of recidivism after transplantation. The high incidence of de novo malignancies in these patients warrants a more comprehensive physical evaluation and better lifestyle modifications to improve long-term outcomes.
背景:肝移植(LT)越来越多地被用于治疗酒精相关性肝病(ALD)。目前尚不清楚ALD患者肝移植频率的增加是否会对死亡供体(DDLT)的分配产生负面影响，以及目前移植前6个月禁欲的政策是否能有效预防移植后再犯或改善长期预后。方法:共纳入506名成人肝移植受体，包括97名ALD患者。将ALD患者与非ALD患者的预后进行比较。根据移植前酒精戒断时间将97例ALD患者进一步分为A组(戒酒6个月)和N组(不戒酒)。比较两组饮酒复发的发生率及长期疗效。结果:2016年之后，ALD的LT患病率显著增加(27.0% vs 14.0%;p < 0.01)，但ALD的DDLT发生率保持不变(22.6% vs 34.1%， p = 0.210)。中位随访56.9个月后，ALD患者和非ALD患者的生存率相当(移植后1、3和5年:分别为87.6%、84.3%和79.5% vs 82.8%、76.6%和72.2%;P = 0.396)。无论移植类型和疾病严重程度如何，结果都是一致的。70例ALD患者中有22例(31.4%)报告移植后饮酒复发，其中A组的患病率高于N组(38.3% vs 17.4%， p = 0.077)。6个月的戒断或不戒断并没有导致生存差异，新发恶性肿瘤是ALD患者晚期死亡的主要原因。结论:肝移植治疗ALD患者效果良好。移植前6个月的戒断并不能预测移植后再犯的风险。这些患者的新发恶性肿瘤发生率高，需要更全面的身体评估和更好的生活方式改变，以改善长期预后。
期刊介绍：
Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health.
JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor
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