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Minerva Gastroenterologica e Dietologica 2011 December;57(4):345-59


language: English

Alcohol drinking after liver transplantation is associated with graft injury

De Simone P. 1, De Geest S. 2, 3, Ducci J. 1, Carrai P. 1, Petruccelli S. 1, Baldoni L. 1, Pollina L. 4, Campani D. 4, Filipponi F. 1

1 General Surgery and Liver Transplantation Unit, Department of Liver Transplantation, Hepatology, and Infectious Disease, University of Pisa Medical School Hospital, Pisa, Italy; 2 Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; 3 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; 4 Department of Pathology, University of Pisa Medical School Hospital, Pisa, Italy


AIM: This was a single-center, mixed-design, cross-sectional and retrospective study to assess the performance of the 4-item, self-reported CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire in predicting histology-proven alcohol-related liver graft injury (ARLGI).
METHODS: A total of 316 liver transplant (LT) patients between six months and five years were enrolled. Based on previous research, problem alcohol drinking (PAD) was defined as any score ≥1 on the CAGE, while a cut-off of 2 was assumed for alcohol dependence (AD).
RESULTS:Responders were 195, 45 (23.1%) had a CAGE score ≥1 and 30 (15.3%) scored ≥2. After controlling for confounders, PAD was associated with hyperlipidemia (P=0.01), while AD with a male gender (P=0.01), hyperlipidemia (P=0.03) and alcohol as native diagnosis (P=0.03). PAD and AD were both associated with a significantly higher prevalence of ARLGI, i.e. 53.3% and 63.3%, respectively (P<0.0001). Hepatitis C virus (HCV) patients with PAD showed more steatosis (P=0.04), portal infiltrate (P=0.03), and pericellular/perivenular fibrosis (P=0.02). The likelihood ratios for CAGE scores ranging from 0 to 4 in predicting ARLGI were 0, 5.2, 7.8, 7.8, and 100, respectively.
CONCLUSION: By use of a self-report instrument we found a 23.1% prevalence of PAD and a 15.3% prevalence of AD among LT patients between six months and five years. A variable degree of ARLGI was present in 53.3% of PAD and 63.3% of AD, respectively. HCV patients with PAD had more steatosis, portal inflammation, and pericellular fibrosis. Transplant physicians might improve their ability to predict the probability for ARLGI using the CAGE.

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