Transplantation for
alcoholic liver disease is becoming increasingly common, and with adequate screening, short- to medium-term outcomes are very good. However, while conducting a prospective study of the outcome of
liver transplantation in Birmingham, United Kingdom, we observed that a research diagnosis of
alcohol abuse or dependence was made in a number of cases in which no reference to
alcohol problems had been made by the referring agency. This article explores the characteristics of these "missed" cases and highlights key patient characteristics that might prompt a more detailed assessment of alcohol consumption. Two hundred eight individuals completed the research interview, and 80 (39%) met Diagnostic and Statistical Manual of Mental Disorders IV criteria for a lifetime diagnosis of either
alcohol abuse (n = 29) or dependence (n = 51). When the initial referral details were reviewed, the possibility of
alcohol problems had not been raised in 10 (12.5%) of these cases.
Hepatitis C was the most common primary diagnosis in the missed cases, but there was no difference between diagnosed and missed cases in terms of demographic factors, severity of
liver disease, or the number or degree of lifetime problems associated with alcohol. However, members of the missed group were more likely to have drunk alcohol in the past 6 months and in a greater volume and were more likely to have used
illicit drugs such as
opiates,
amphetamines,
hallucinogens, and cannabis. These findings point to the need to take an adequate history of lifetime
alcohol problems in all patients being considered for
liver transplantation.