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Severe alcoholic relapse rare after LT, recurrent cirrhosis more likely after relapse

In a new study published by the American Journal of Gastroenterology, researchers in France found severe alcoholic relapse to be rare after liver transplantation. However, recurrent alcoholic cirrhosis was found to develop over time in patients who did experience relapse after transplant.

“Because [alcoholic liver disease] is one of the leading indications for [liver transplant], liver graft damage induced by severe alcoholic relapse needs to be closely evaluated by the [liver transplant] community,” the researchers wrote. “This study reports the comprehensive results of the largest series to date.”

Researchers, including Jérôme Dumortier MD, PhD, of the Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France, analyzed data of  1,894 patients who underwent liver transplant due to alcoholic liver disease (ALD) at three clinical centers in France between 1990 and 2007. Of these patients, 712 received transplants for alcoholic cirrhosis and survived more than 6 months.

The mean follow-up of the study was 9 years and the diagnosis of recurrent alcoholic cirrhosis (RAC) was based on “histological evidence or a series of features combined with severe alcoholic relapse,” according to the research.

Over the course of follow-up, 18% of the patients experienced severe alcoholic relapse (n = 128). The rate at which severe alcoholic relapse occurred was a median delay of 25 months after transplant.

Thirty-two percent of patients who experienced severe alcoholic relapse developed RAC (n = 41). RAC diagnosis was made after a median delay of 5.1 years after transplant and 4 years after severe alcoholic relapse. RAC was found in 5.8% of all 712 patients with liver transplant (LT) due to ALD.

Univariate analysis showed younger age and a shorter period of pre-transplant abstinence from alcohol to be associated with developing severe alcoholic relapse and RAC.

Patients who did not develop RAC had higher survival rates at 5 years (89.4% vs. 87.6%), 10 years (69.9% vs. 49.7%) and 15 years (41.1% vs. 21%; P < .001) post-transplant.

“The main results of the present study are that severe alcoholic relapse is a relatively rare event, which occurred in [less than] 20% of our cases, whereas RAC affected one-third of these patients 10 years after LT with an accelerated course and a very poor prognosis,” the researchers wrote. “Regular assessment of alcohol use should be a major goal of post-transplantation care and all measures to prevent … severe alcoholic relapse would improve patient survival.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.