Korean J Intern Med.  2020 Jul;35(4):797-810. 10.3904/kjim.2019.409.

Alcohol use disorder and liver transplant: new perspectives and critical issues

• Gitto S
• Aspite S
• Golfieri L
• Caputo F
• Vizzutti F
• Grandi S
• Patussi V
• Marra F

• KMID: 2504171
• DOI: http://doi.org/10.3904/kjim.2019.409

Abstract

Alcoholic liver disease is a consolidated indication for liver transplantation, but many unsolved issues can be highlighted. Patients with alcohol use disorder develop peculiar comorbidities that can become contraindications for transplantation. Moreover, a number of social and psychological patterns should be evaluated to select candidates with a low risk of alcohol relapse and adequate post-transplant adherence. In this context, the 6-month rule is too rigid to be widely applied. A short period of abstinence (1 to 3 months) is useful to estimate recovery of liver function and, possibly to avoid transplant. Cardiovascular disorders and extra-hepatic malignancies represent the main clinical issues after transplant. Patients transplanted due to alcoholic disease are a major risk for other liver diseases. Severe corticosteroid-resistant alcoholic acute hepatitis is a debated indication for transplant. However, available data indicate that well-selected patients have excellent post-transplant outcomes. Behavioral therapy, continued psychological support and a multidisciplinary team are essential to achieve and maintain complete alcohol abstinence during the transplant process. Alcoholic liver disease is an excellent indication for a liver transplant but patients with alcohol use disorder deserve a personalized approach and dedicated resources.

Keyword

Liver diseases, alcoholic; Alcoholism; Alcohol and transplant