REVIEW  LIVER TRANSPLANTATION: INDICATIONS AND OUTCOMES 

Minerva Gastroenterologica e Dietologica 2018 June;64(2):126-37

DOI: 10.23736/S1121-421X.17.02463-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Indications for and outcomes of liver transplantation in patients with alcohol-associated liver disease

Paulina K. PHILLIPS ^{1, 2}, Matthew W. CALDIS ², Alexander D. HRISTOV ², Alexander S. LEE ², Michael R. LUCEY ^{1, 2} ✉

¹ Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; ² Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

The manufacture and consumption of alcohol are ubiquitous and as old as time. Alcohol use disorder (AUD) is defined as a problematic pattern of alcohol use leading to clinically significant impairment. The physical injuries that result from excessive alcohol consumption are varied including end-organ damage to liver (alcohol-associated liver disease [ALD]), pancreas, brain and heart, and systemic consequences including several forms of cancer. Liver transplantation (LT) remains the treatment of last resort for life-threatening liver disease. LT provides a valuable magnifying glass under which to examine the complex interactions between social drinking, AUD, and ALD. ALD is the second most frequent indication for LT in the US (data of 2015). We review the current data on evaluation of patients with AUD and ALD for liver transplantation; on the significance of abstinence from alcohol in patient selection and pre- and post-LT management. We discuss monitoring for relapse prior to and after LT. Finally, we look at outcomes, first from the perspective of impact on the allograft and then the perspective of maintaining the health of the LT patient with AUD, which includes management of addiction.

KEY WORDS: Alcohol-related disorders - Alcoholism - Liver transplantation