Jain A, DiMartini A, Kashyap R, Youk A, Rohal S, Fung J
Thomas E. Starzl Transplantation Institute, Department of Psychiatry, University of Pittsburgh, Pennsylvania 15213, USA.
Transplantation. 2000 Nov 15;70(9):1335-42. doi: 10.1097/00007890-200011150-00012.
Liver transplantation (LTx) for alcohol-related liver disease (ALD) is an accepted modality of treatment and is one of the most common indications for LTx in the United States. The present report examines the long-term patient survival, graft survival, rates of recidivism, and development of de novo cancers in this group, and compares these results with a contemporaneous group of patients who were transplanted for non-ALD indications.
Between August 1989 and December 1992, 185 adults received LTx for ALD (group I). During the same time interval, 649 adults received LTx for non-ALD (group II). The mean follow-up time was 94+/-10.7 months for group I vs. 92+/-11 months for group II. Kaplan-Meier survival estimates and the incidence of cancers using Surveillance Epidemiologic End Result data were compared in both groups.
At 5 years after orthotopic LTx, the overall patient survival and graft survival for group I were 72.0% and 66.5% vs. 66.5% and 60.3% for group II, respectively. After 5 years, the patient survival and graft survival for the alcoholic group were significantly lower (P=0.001) compared to the non-alcoholic group. The rate of de novo oropharyngeal cancer and lung cancer was 25.5 times and 3.7 times higher, respectively, in ALD group compared with the general population matched for age, sex, and length of follow-up (P=0.001), whereas this was not higher in the non-ALD group. Prior pretransplant length of sobriety and alcohol rehabilitation was not associated with the rate of post-LTx rate of recidivism, which was 20%. Out of 79 deaths in group I, only 1 was attributed to recidivism and 3 to noncompliance with recidivism. The other deaths occurred from de novo cancer (n=13), posttransplant lymphoproliferative disorder (n=5), age-related complications (n=23), and other infection or miscellaneous causes (n=34).
Patient and graft survival past 5 years after orthotopic LTx is significantly lower for ALD for a variety of reasons (P=0.001). The rate of upper airway malignances was significantly higher in ALD patients than for non-ALD post-LTx patients and the general public. Graft loss/death related to recidivism or chronic rejection was extremely low. More attention is needed for early diagnosis of de novo cancer and prevention of cardiorespiratory and cerebrovascular complications.
酒精性肝病（ALD）的肝移植（LTx）是一种公认的治疗方式，且是美国肝移植最常见的适应证之一。本报告研究了该组患者的长期生存、移植物存活、复发率及新发癌症的发生情况，并将这些结果与同期因非ALD适应证接受移植的患者组进行比较。
1989年8月至1992年12月期间，185例成人因ALD接受肝移植（I组）。在同一时间段，649例成人因非ALD接受肝移植（II组）。I组的平均随访时间为94±10.7个月，II组为92±11个月。比较两组采用Kaplan-Meier生存估计法得出的生存率以及利用监测、流行病学和最终结果数据得出的癌症发病率。
原位肝移植术后5年，I组患者的总体生存率和移植物存活率分别为72.0%和66.5%，II组分别为66.5%和60.3%。5年后，酒精性肝病组的患者生存率和移植物存活率显著低于非酒精性肝病组（P = 0.001）。与年龄、性别和随访时间相匹配的普通人群相比，ALD组的新发口咽癌和肺癌发生率分别高出25.5倍和3.7倍（P = 0.001），而非ALD组则没有更高。移植前戒酒和酒精康复的时长与肝移植术后20%的复发率无关。I组的79例死亡中，仅1例归因于复发，3例归因于不遵守复发规定。其他死亡原因包括新发癌症（n = 13）、移植后淋巴细胞增生性疾病（n = 5）、与年龄相关的并发症（n = 23）以及其他感染或杂项原因（n = 34）。
由于多种原因，原位肝移植术后5年以上，ALD患者的生存率和移植物存活率显著较低（P = 0.001）。ALD患者上呼吸道恶性肿瘤的发生率显著高于非ALD肝移植术后患者和普通人群。与复发或慢性排斥相关的移植物丢失/死亡极低。需要更多关注新发癌症的早期诊断以及心肺和脑血管并发症的预防。
