Abosh D, Rosser B, Kaita K, Bazylewski R, Minuk G
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Gastroenterol. 2000 Nov;14(10):851-5. doi: 10.1155/2000/867514.
To document and compare the outcomes of adult patients who received liver transplants for alcohol- and nonalcohol-induced liver diseases who attended a liver transplantation follow-up clinic in an urban, nontransplantation centre at a time when no formal alcohol abuse program for transplant candidates and/or recipients was offered.
The study population comprised 10 alcoholic patients and 48 nonalcoholic patients followed for an average of 41 months (range five to 79 months) and 46 months (range two to 116 months), respectively. Primary outcome variables included rates of recidivism, duration of abstinence after transplantation and compliance with post-transplant medical follow-up visits. Time to discharge after transplantation, episodes of graft rejection, liver and renal biochemical abnormalities, diabetes, hypertension, sepsis, strictures, complications unrelated to transplantation and changes in psychosocial status were secondary outcome variables.
Significant differences were found with respect to a higher incidence of recidivism (50% for alcoholic patients compared with 2% for nonalcoholic patients, P<0.0001), a shorter period of abstinence after transplantation (14.7+/-17.2 months for alcoholic patients compared with 26.3+/-23.0 months for nonalcoholic patients, P<0.05) and more missed office visits (2.7+/-3.5 for alcoholic patients compared with 1.0+/-1.9 for nonalcoholic patients, P=0.05) in the alcoholic group. The alcoholic group also had a lower incidence of rejection episodes (10% for alcoholic patients compared with 44% for nonalcoholic patients, P<0.05) but higher rates of post-transplantation diabetes (40% for alcoholic patients compared with 2% for nonalcoholic patients, P<0.05), more nontransplantation-related complications (20% for alcoholic patients compared with 0% for nonalcoholic patients, P<0.05), and higher serum creatinine but lower bilirubin and cyclosporine A levels (P<0.05, respectively). Marital separations were also more common in the alcoholic group (20% for alcoholic patients compared with 0% for nonalcoholic patients, P<0.05).
In the absence of formal alcohol abuse programs, the post-transplantation outcome in alcoholic patients generally does not compare well with that of patients who undergo transplantation for nonalcohol-related liver diseases.
记录并比较在一个城市非移植中心的肝脏移植随访门诊接受酒精性和非酒精性肝病肝移植的成年患者的治疗结果，该中心当时未为移植候选者和/或接受者提供正式的酒精滥用治疗项目。
研究人群包括10例酒精性肝病患者和48例非酒精性肝病患者，分别平均随访41个月（范围5至79个月）和46个月（范围2至116个月）。主要结局变量包括复发率、移植后戒酒持续时间以及对移植后医学随访的依从性。移植后出院时间、移植排斥发作次数、肝脏和肾脏生化异常、糖尿病、高血压、败血症、狭窄、与移植无关的并发症以及心理社会状态变化为次要结局变量。
发现酒精性肝病患者组在复发率更高（酒精性肝病患者为50%，非酒精性肝病患者为2%，P<0.0001）、移植后戒酒时间更短（酒精性肝病患者为14.7±17.2个月，非酒精性肝病患者为26.3±23.0个月，P<0.05）以及错过门诊就诊次数更多（酒精性肝病患者为2.7±3.5次，非酒精性肝病患者为1.0±1.9次，P=0.05）方面存在显著差异。酒精性肝病患者组移植排斥发作的发生率也较低（酒精性肝病患者为10%，非酒精性肝病患者为44%，P<0.05），但移植后糖尿病发生率较高（酒精性肝病患者为40%，非酒精性肝病患者为2%，P<0.05），与移植无关的并发症更多（酒精性肝病患者为20%，非酒精性肝病患者为0%，P<0.05），血清肌酐水平较高但胆红素和环孢素A水平较低（分别为P<0.05）。酒精性肝病患者组婚姻关系破裂也更为常见（酒精性肝病患者为20%，非酒精性肝病患者为0%，P<0.05）。
在没有正式酒精滥用治疗项目的情况下，酒精性肝病患者的移植后结局总体上不如因非酒精性肝病接受移植的患者。
