Berlakovich G A, Steininger R, Herbst F, Barlan M, Mittlböck M, Mühlbacher F
Department of Transplant Surgery, University of Vienna, Austria.
Transpl Int. 1994;7 Suppl 1:S123-7. doi: 10.1111/j.1432-2277.1994.tb01329.x.
Many transplant centres are reluctant to accept alcoholic patients because of their supposed potential for alcoholic recidivism, resulting in graft failure and recurrence of alcoholic liver cirrhosis. From May 1982 to January 1993 80 patients received orthotopic liver transplantation (OLT) at our institution either for alcoholic cirrhosis exclusively (n = 58) or for a hepatoma in an alcoholic cirrhosis (n = 22). The outcome of these patients was analysed with particular attention to recurrence of liver disease. Overall survival in this group was 67% and 49% at 1 and 5 years, respectively, with a median follow-up of 45 months. Actuarial survival of patients transplanted since January 1989 (n = 46) and 84% and 82% at 1 and 2 years (median follow-up 31 months). Non-fatal clinical endpoints were analysed in those patients surviving for at least 3 months (n = 61). Return to alcohol abuse was documented in 16 patients at routine short-term out patient check-ups. All patients except one admitted to taking alcohol and showed changes in their laboratory test results. A specific pattern of liver function test values related to alcohol abuse was not detected and at the end of a relapse the liver function values usually returned to pre-event values. Only in one case was toxic injury of the liver related to alcoholic recidivism diagnosed on percutaneous liver needle biopsy or post-mortem examination. Compliance with the required immunosuppressive regimen and social rehabilitation after OLT were excellent. Unwillingness to offer OLT to individuals with alcoholic liver disease because of failure to demonstrate 100% long-term abstinence appears difficult to defend in the face of results showing good survival, compliance and social rehabilitation. The hypothesis of a higher sensitivity of the transplanted liver to a drinking episode and the redevelopment of alcoholic diesease in the new liver was not confirmed in our study population.
许多移植中心不愿接收酗酒患者，因为他们被认为有再次酗酒的潜在可能，从而导致移植失败和酒精性肝硬化复发。1982年5月至1993年1月，我院有80例患者接受了原位肝移植（OLT），其中仅因酒精性肝硬化接受移植的有58例，因酒精性肝硬化合并肝癌接受移植的有22例。对这些患者的预后进行了分析，特别关注了肝病的复发情况。该组患者1年和5年的总生存率分别为67%和49%，中位随访时间为45个月。1989年1月以后接受移植的患者（n = 46），1年和2年的精算生存率分别为84%和82%（中位随访时间31个月）。对存活至少3个月的患者（n = 61）的非致命临床终点进行了分析。在常规短期门诊检查中，有16例患者被记录到再次酗酒。除1例患者外，所有患者均承认饮酒，且实验室检查结果有变化。未检测到与酗酒相关的特定肝功能测试值模式，复发结束时肝功能值通常恢复到事件前水平。仅在1例病例中，经皮肝穿刺活检或尸检诊断出与酒精性复发相关的肝毒性损伤。OLT术后对所需免疫抑制方案的依从性和社会康复情况良好。鉴于结果显示有良好的生存率、依从性和社会康复情况，因未能证明100%长期戒酒而不愿为酒精性肝病患者提供OLT的做法似乎难以成立。在我们的研究人群中，未证实移植肝对饮酒事件更敏感以及新肝中酒精性疾病再次发生的假设。
