Liver transplantation in alcoholic liver disease

There is controversy concerning the priority to be given to patients requiring a liver transplant due to alcoholic liver disease (ALD).

The results of liver transplantation for ALD are as good as the results for non-alcoholics:

• 1 year survival of 85%
• 5 year survival of 70%
• similar outcomes up to 10 years

Return to drinking post-transplant is:

• a quarter at one year
• a third at three years

Because return to drinking is thought to be a bad prognostic factor most centres insist that potential recipients abstain from alcohol (NICE suggest abstinence for at least 3 months) before they are considered for a liver transplant.

Referral for consideration of transplantation

NICE suggest to refer patients with decompensated liver disease to be considered for assessment for liver transplantation if they:

• still have decompensated liver disease after best management and 3 months' abstinence from alcohol and
• are otherwise suitable for transplantation

For the nationally agreed guidelines for liver transplant assessment in the context of alcohol-related liver disease, see www.uktransplant.org.uk/ukt/about_transplants/organ_allocation/pdf/liver_advisory_group_alcohol_guidelines-november_2005.pdf

Reference:

• 1) McMaster, P. Transplantation for alcholic liver disease in an era of organ shortage. Lancet 2000;355:424-5.
• 2) NICE (June 2010). Alcohol use disorders.