Can an alcoholic get a liver transplant?

Liver transplantation for individuals with alcoholic liver disease, including alcoholic cirrhosis and acute alcoholic hepatitis, has become an accepted therapy. Historically, a common requirement for eligibility for liver transplantation in alcoholics was a period of 6 months of alcohol abstinence (Singal et al., 2012; Weinrieb et al., 2000). However, recent studies have challenged the strict adherence to this abstinence period as the sole criterion for transplant eligibility in patients with alcoholic liver cirrhosis (Hajifathalian et al., 2016). Liver transplantation is considered a life-saving option for patients with severe alcoholic hepatitis who have failed medical management and meet all other standard transplantation criteria (Dureja & Lucey, 2010). In fact, refractory alcoholic hepatitis has emerged as a new indication for liver transplantation in carefully selected non-responders to corticosteroids (Marot et al., 2020).

Alcoholic liver disease is a significant indication for liver transplantation, representing the second most common reason for liver transplants in the United States and Europe (Lim et al., 2017; Winckler et al., 2010; Cuadrado et al., 2005). Despite the controversies surrounding liver transplantation for alcoholic liver disease, studies have shown that the outcomes after liver transplantation for alcoholic hepatitis are comparable to those for alcoholic cirrhosis (Lim et al., 2017). However, alcohol relapse post-transplantation remains a concern, as it can negatively impact long-term patient survival (Cuadrado et al., 2005). Factors influencing relapse and survival post-transplantation in patients with alcohol-induced liver disease have been studied extensively (Schneekloth et al., 2021).

In conclusion, while liver transplantation is a viable treatment option for individuals with alcoholic liver disease, including alcoholic hepatitis, careful patient selection, comprehensive psychosocial assessments, and ongoing support for alcohol abstinence are crucial to ensure successful outcomes post-transplantation. The evolving landscape of liver transplantation for alcoholic liver disease necessitates a nuanced approach that considers individual patient characteristics and risk factors for relapse.

References:

1. Cuadrado, A., Fábrega, E., Casafont, F., & Pons‐Romero, F. (2005). Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease. Liver Transplantation, 11(4), 420-426. https://doi.org/10.1002/lt.20386
2. Dureja, P. and Lucey, M. (2010). The place of liver transplantation in the treatment of severe alcoholic hepatitis. Journal of Hepatology, 52(5), 759-764. https://doi.org/10.1016/j.jhep.2009.12.021
3. Hajifathalian, K., Humberson, A., Hanouneh, M., Barnes, D., Arora, Z., Zein, N., … & Hanouneh, I. (2016). Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease. World Journal of Hepatology, 8(27), 1149. https://doi.org/10.4254/wjh.v8.i27.1149
4. Lim, J., Curry, M., & Sundaram, V. (2017). Risk factors and outcomes associated with alcohol relapse after liver transplantation. World Journal of Hepatology, 9(17), 771. https://doi.org/10.4254/wjh.v9.i17.771
5. Marot, A., Moreno, C., & Deltenre, P. (2020). Liver transplant for alcoholic hepatitis: a current clinical overview. Expert Review of Gastroenterology & Hepatology, 14(7), 591-600. https://doi.org/10.1080/17474124.2020.1775579
6. Schneekloth, T., Arab, J., Simonetto, D., Petterson, T., Niazi, S., Hall‐Flavin, D., … & Rosen, C. (2021). Factors having an impact on relapse and survival in transplant recipients with alcohol-induced liver disease. Mayo Clinic Proceedings Innovations Quality & Outcomes, 5(6), 1153-1164. https://doi.org/10.1016/j.mayocpiqo.2021.10.005
7. Singal, A., Hmoud, B., Anand, B., Jampana, S., Singal, V., & Kuo, Y. (2012). Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: exploratory analysis from the unos database. Hepatology, 55(5), 1398-1405. https://doi.org/10.1002/hep.25544
8. Weinrieb, R., Horn, D., McLellan, A., & Lucey, M. (2000). Interpreting the significance of drinking by alcohol-dependent liver transplant patients: fostering candor is the key to recovery. Liver Transplantation, 6(6), 769-776. https://doi.org/10.1053/jlts.2000.18497
9. Winckler, C., Biagioni, D., Paula, R., Gomes, M., Llanos, J., Neto, A., … & Polonio, R. (2010). Demographic profile in liver transplant candidates on waiting list. Brazilian Journal of Transplantation, 10(1), 660-663. https://doi.org/10.53855/bjt.v10i1.323