Severe alcoholic relapse after liver transplantation: What consequences on the graft? A study based on liver biopsies analysis.

Abstract

Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse. The aims of this study were to evaluate the impact of severe alcoholic relapse on the graft (based on histological examination) and to identify predictive factors associated with recurrent alcoholic cirrhosis (RAC). From 1990 to 2010, 369 patients underwent LT for ALD at Edouard Herriot Hospital (Lyon, France) and survived more than 1 year. All patients who presented severe alcoholic relapse and histological follow-up were included. Liver biopsies were performed at 1 and 5 years and at every 5 years after LT, and when clinically indicated. The median follow-up after LT was 11 years (range, 3-18 years). Severe alcoholic relapse was observed in 73 (20%) of the 369 patients, from whom 56 patients with histological evaluation were included. RAC was diagnosed in 18 (32%) of the 56 patients included, which represents 5% of the 369 patients transplanted for ALD. The median delay between LT and RAC was 6 years (range, 3-10 years) and 4.5 years (range, 2-8 years) after severe alcoholic relapse. The median cumulated years of alcohol use before RAC was 3.5 years (range, 2-7 years). The cumulative risk for F4 fibrosis was 15% at 3 years, 32% at 5 years, and 54% at 10 years after severe alcoholic relapse. A young age at LT (≤50 years old) and an early onset of heavy drinking (within the first 3 years after LT) were associated with RAC. In conclusion, severe alcoholic relapse usually occurs in the first years after LT and is responsible for accelerated severe graft injury. Liver Transplantation 22 773-784 2016 AASLD.

• Authors: Domitille Erard-Poinsot, Olivier Guillaud, Valérie Hervieu, Elsa Thimonier, Mélanie Vallin, Christine Chambon-Augoyard, Olivier Boillot, Jean-Yves Scoazec, Jérôme Dumortier
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 22 Issue 6 Pg. 773-84 (06 2016) ISSN: 1527-6473 [Electronic] United States
• PMID: 26929100 (Publication Type: Journal Article)
• Copyright: © 2016 American Association for the Study of Liver Diseases.

Topics

• Adult
• Age Factors
• Aged
• Alcohol Abstinence
• Alcoholism (complications)
• Allografts (pathology)
• Biopsy
• Chronic Disease
• Female
• Follow-Up Studies
• France (epidemiology)
• Graft Rejection (chemically induced, epidemiology, pathology)
• Humans
• Liver (pathology)
• Liver Cirrhosis, Alcoholic (mortality, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Recurrence
• Risk Factors
• Time Factors