Korean J Hepatobiliary Pancreat Surg.  2013 Feb;17(1):14-20. 10.14701/kjhbps.2013.17.1.14.

Living donor liver transplantation for patients with alcoholic liver disease

• Park YH
• Hwang S
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Namgoong J
• Park HW
• Park CS
• Kang SH
• Jung BH
• Lee SG

• KMID: 2243164
• DOI: http://doi.org/10.14701/kjhbps.2013.17.1.14

Abstract

BACKGROUNDS/AIMS
Since most transplantation studies for alcoholic liver disease (ALD) were performed on deceased donor liver transplantation, little was known following living donor liver transplantation (LDLT).
METHODS
The clinical outcome of 18 ALD patients who underwent LDLT from Febraury 1997 to December 2004 in a large-volume liver transplantation center was assessed retrospectively.
RESULTS
The model for end-stage liver disease score was 23+/-11, and mean pretransplant abstinence period was 16+/-13 months, with 14 (77.8%) patients being abstinent for at least 6 months. Graft types were right lobe grafts in 11, left lobe grafts in 2 and dual grafts in 5. Graft to recipient body weight ratio was 0.94+/-0.16. The relapse rates in patients who did and did not maintain 6 months of abstinence were 7.1% and 50%, respectively (p=0.097). Younger recipient age was a significant risk factor for alcohol relapse (p=0.027). Five recipients with antibody to hepatitis B surface antigen (HBsAg) received core antibody-positive liver graft, but two of them showed positive HBsAg seroconversion. Overall 5-year patient survival rate following LDLT was 87.8%, with a 5-year relapse rate of 16.7%.
CONCLUSIONS
Pretransplant abstinence for 6 months appears to be benefical for preventing posttransplant relapse. Life-long prophylactic measure should be followed after use of anti-HBc-positive liver grafts regardless of hepatitis B viral marker status of the recipient.

Keyword

Living donor liver transplantation; Alcoholic liver disease; Relapse

MeSH Terms

Alcoholics
Biomarkers
Body Weight
Hepatitis B
Hepatitis B Surface Antigens
Humans
Liver
Liver Diseases
Liver Diseases, Alcoholic
Liver Transplantation
Living Donors
Recurrence
Risk Factors
Survival Rate
Tissue Donors
Transplants
Hepatitis B Surface Antigens

Figure

• 

  Fig. 1 Cumulative overall and alcohol relapse-free survival curves of 18 alcoholic liver disease patients who underwent living donor liver transplantation. Overall 1-year, 3-year and 5-year patient survival rates were 100%, 100% and 87.8%, respectively (solid line). Relapse-free 1-year, 3-year and 5-year survival rates were 95.4%, 83.3% and 83.3%, respectively (dotted line).

• 

  Fig. 2 Computed tomography (CT) follow-up of a 35-year-old male patient who showed severe alcohol intake after living donor liver transplantation using dual liver grafts. (A) Preoperative CT scan showing cirrhotic changes. Model for end-stage liver disease score was 30. (B) 3 month CT scan showing marked steatosis at both of the dual grafts. Liver biopsy confirmed severe fatty change, which was a result of posttransplant alcohol abuse for 2-3 months. Hepatorenal syndrome occurred at 5 months posttransplant. Serum total bilirubin concentration exceeded 40 mg/dl. Acute renal failure was managed with continuous venovenous hemodiafiltration. (C) After 1 month of supportive care in the intensive care unit, the patient's liver function recovered progressively. This CT scan was taken at posttransplant 8 months. The right-sided graft looked normal, but the left-sided graft revealed marked atrophic change. (D) At 2 years after liver transplantation, the left-sided graft was completely atrophied, whereas the right-sided graft became hypertrophied. This patient died from aspergillus pneumonia 36 months after transplantation.

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