Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden:: Impact of structured management on recidivism

被引:95
作者
Björnsson, E
Olsson, J
Rydell, A
Fredriksson, K
Eriksson, C
Sjöberg, C
Olausson, M
Bäckman, L
Castedal, M
Friman, S
机构
[1] Sahlgrens Univ Hosp, Dept Internal Med, Sect Gastroenterol & Hepatol, S-41345 Gothenburg, Sweden
[2] Sahlgrens Univ Hosp, Dept Hepat Surg & Liver Transplantat, S-41345 Gothenburg, Sweden
关键词
alcoholic liver disease; alcohol recidivism; liver transplantation; malignancy;
D O I
10.1080/00365520410009591
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective. No systematic evaluation has been performed previously in the Scandinavian countries on patients transplanted for alcoholic liver disease (ALD). Data are limited on the impact of structured management of the alcohol problem on the risk of recidivism following transplantation in ALD. Material and methods. A total of 103 ALD patients were compared with a control group of patients with non-alcoholic liver disease (NALD). The recidivism rates for ALD patients transplanted between 1988 and 1997 as well as after 1998 ( institution of structured management) were compared. Results. The median follow-up was 31 ( 6 - 60) months in the ALD group and 37 ( 12 - 63) months in the control group (NS). The overall survival rates at 1- and 5 years were, respectively, 81) and 69) for the ALD group and 87) and 83) for the non-alcoholic group. The proportion of patients with Child-Pugh C (75%) was higher in ALD patients than in NALD patients (44%) ( p< 0.01). Thirty-two (33%) ALD patients resumed taking some alcohol after transplantation; 17 patients (18%) were heavy drinkers. A multivariate analysis showed that: sex, age, marital and employment status, benzodiazepine use and a history of illicit drug abuse did not predict the risk of alcohol relapse post-Tx. Nineteen out of 40 (48%) patients transplanted before the start of structured management had resumed alcohol but 13 (22%) out of 58 after this intervention ( p = 0.002). Conclusions. ALD is a good indication for liver transplantation, with similar results in the ALD patients. Structured management of the alcohol problem before and after transplantation is important in minimizing the risk of recidivism.
引用
收藏
页码:206 / 216
页数:11
相关论文
共 31 条
[1]   Liver transplantation for alcoholic cirrhosis: Long term follow-up and impact of disease recurrence [J].
Bellamy, COC ;
DiMartini, AM ;
Ruppert, K ;
Jain, A ;
Dodson, F ;
Torbenson, M ;
Starzl, TE ;
Fung, JJ ;
Demetris, AJ .
TRANSPLANTATION, 2001, 72 (04) :619-626
[2]   EFFICACY OF LIVER-TRANSPLANTATION FOR ALCOHOLIC CIRRHOSIS WITH RESPECT TO RECIDIVISM AND COMPLIANCE [J].
BERLAKOVICH, GA ;
STEININGER, R ;
HERBST, F ;
BARLAN, M ;
MITTLBOCK, M ;
MUHLBACHER, F .
TRANSPLANTATION, 1994, 58 (05) :560-565
[3]   LIVER-TRANSPLANTATION IN PATIENTS WITH ALCOHOLIC CIRRHOSIS - SELECTION CRITERIA AND RATES OF SURVIVAL AND RELAPSE [J].
BIRD, GLA ;
OGRADY, JG ;
HARVEY, FAH ;
CALNE, RY ;
WILLIAMS, R .
BRITISH MEDICAL JOURNAL, 1990, 301 (6742) :15-17
[4]  
Bjoro K, 1999, SCAND J GASTROENTERO, V34, P714
[5]   Employment and alcohol use after liver transplantation for alcoholic and nonalcoholic liver disease: A systematic review [J].
Bravata, DM ;
Olkin, I ;
Barnato, AE ;
Keeffe, EB ;
Owens, DK .
LIVER TRANSPLANTATION, 2001, 7 (03) :191-203
[6]  
Campbell DA, 1998, LIVER TRANSPLANT SUR, V4, pS58
[7]   Liver transplantation in patients with alcohol and other substance use disorders [J].
DiMartini, A ;
Weinreb, R ;
Fireman, M .
PSYCHIATRIC CLINICS OF NORTH AMERICA, 2002, 25 (01) :195-+
[8]   Defining the alcoholic liver transplant population: Implications for future research [J].
DiMartini, A ;
Weinrieb, R ;
Lane, T ;
Day, N ;
Fung, J .
LIVER TRANSPLANTATION, 2001, 7 (05) :428-431
[9]   Alcohol use following liver transplantation -: A comparison of follow-up methods [J].
DiMartini, A ;
Day, N ;
Dew, MA ;
Lane, T ;
Fitzgerald, MG ;
Magill, J ;
Jain, A .
PSYCHOSOMATICS, 2001, 42 (01) :55-62
[10]  
Everhart J E, 1997, Liver Transpl Surg, V3, P220, DOI 10.1053/jlts.1997.v3.ajlts0030220