학술논문
Long-term outcomes of liver transplantation for alcohol-related liver disease.
Document Type
Academic Journal
Author
Lin NC; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Liu C; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Chen CY; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Lei HJ; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Tsou YF; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Kuo FC; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Chou SC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Chung MH; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Hsia CY; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Loong CC; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Wang SC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Lee OK; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan, ROC.; Center for Translational Genomics and Regenerative Medicine Research, China Medical University Hospital, Taichung, Taiwan, ROC.; Tsai HL; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Source
Publisher: Wolters Kluwer Health Country of Publication: Netherlands NLM ID: 101174817 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1728-7731 (Electronic) Linking ISSN: 17264901 NLM ISO Abbreviation: J Chin Med Assoc Subsets: MEDLINE
Subject
Language
English
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.
Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
(Copyright © 2023, the Chinese Medical Association.)
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.
Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
(Copyright © 2023, the Chinese Medical Association.)