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Excessive alcohol consumption post-liver transplant reduced long-term survival

Patients who underwent liver transplantation and experienced excessive alcohol relapse had a reduced chance for long-term survival in a recent study.

In a retrospective analysis, researchers evaluated 441 patients who underwent a primary liver graft between 1991 and 2007 and survived for more than 6 months. Patients attended semiweekly clinics after the first month, monthly during the first year, every 2 months during the second year, quarterly in the third year and semiannually in subsequent years, for a mean follow-up of 81.7 months.

Of the original cohort, 281 patients indicated excessive alcohol consumption (more than 20 g/day for women; 30 g/day for men) before transplant, including 206 with a primary indication of alcohol-related liver disease (ALD). Following transplantation, 32.3% of 424 evaluable patients reported alcohol consumption, including 43.7% of those with ALD as the primary indication and 24.3% of those without. Consumption was excessive in 13.2% of the cohort (56 patients), including 49 patients with ALD as the primary indication.

One hundred eighteen patients died during follow-up, with nonhepatic cancer and recurrence as the most common causes of death. Investigators observed a survival rate of 82% at 5 years and 49% at 10 years among these patients, compared with 86% at 5 years and 75% at 10 years among those who did not experience excessive alcohol relapse.

Multivariate analysis indicated excessive alcohol relapse (HR=2.08; 95% CI, 1.23-3.52) as an independent risk factor for death, along with age greater than 51 years at transplant (HR=1.56; 95% CI, 1.03-2.67), post-transplant diabetes (HR=1.50; 95% CI, 1.01-2.23), cyclosporine-based immunosuppression (HR=1.54; 95% CI, 1.02-2.33) and nonhepatic cancer (HR=2.22; 95% CI, 1.48-3.33).

“This study demonstrates that excessive alcohol consumption has a negative impact on long-term survival after [liver transplant], irrespective of the primary indication for transplantation,” the researchers concluded. “The relapse to excessive drinking must be prevented in all liver transplant recipients, and if it occurs, it should be dealt with as quickly as possible. Even though it occurs mainly in patients who have been transplanted for ALD, it should also be checked for in patients with other primary indications.”