Miguet Mathieu, Monnet Elisabeth, Vanlemmens Claire, Gache Pascal, Messner Michel, Hruskovsky Stephane, Perarnau Jean Marc, Pageaux Georges-Philippe, Duvoux Christophe, Minello Anne, Hillon Patrick, Bresson-Hadni Solange, Mantion Georges, Miguet Jean-Philippe
Hôpital Jean Minjoz, Besançon.
Gastroenterol Clin Biol. 2004 Oct;28(10 Pt 1):845-51. doi: 10.1016/s0399-8320(04)95146-9.
The objective of this prospective study was to determine whether sociological and/or alcohol-related behavioral factors could be predictive of relapse after orthotopic liver transplantation for alcoholic liver disease.
Fifty-five liver-transplanted patients out of a series of 120 alcoholic cirrhotic patients were enrolled in a randomized prospective study. This study was initially designed to compare the 2 year survival in intent-to-transplant patients versus in-intent-to-use conventional treatment patients. For all patients, an identical questionnaire was completed at inclusion, and every 3 months for 5 years to collect data on alcohol-related behavior factors.
Fifty-one patients fulfilled the criteria for the study. The mean follow-up was 35.7 months (range: 1-86). Rate of alcohol relapse was 11% at one year and 30% at 2 years. Alcohol intake above 140 g a week was declared by 11% and 22% of patients at one and 2 years, respectively. The only variable leading to a significantly lower rate of relapse was abstinence for 6 months or more before liver transplantation (23% vs 79%, P=0.0003). This variable was also significant for patients whose alcohol intake was greater than 140 g per week (P=0.003) (adjusted relative risk=5.5; 95%CI=1.3-24.5; P=0.02). Multivariate analysis (Cox model) showed that abstinence for 6 months or more before liver transplantation was the unique predictive variable.
In this prospective study of 51 patients transplanted for alcoholic liver disease, abstinence before liver transplantation was the only predictive factor of alcohol relapse after liver transplantation.
本前瞻性研究旨在确定社会学和/或与酒精相关的行为因素是否可预测酒精性肝病原位肝移植后的复发情况。
在120例酒精性肝硬化患者中，55例肝移植患者被纳入一项随机前瞻性研究。本研究最初旨在比较意向性肝移植患者与意向性采用传统治疗患者的2年生存率。对于所有患者，在纳入时填写相同的问卷，并在5年中每3个月收集一次与酒精相关行为因素的数据。
51例患者符合研究标准。平均随访时间为35.7个月（范围：1 - 86个月）。1年时酒精复发率为11%，2年时为30%。分别有11%和22%的患者在1年和2年时宣称每周酒精摄入量超过140克。导致复发率显著降低的唯一变量是肝移植前戒酒6个月或更长时间（23%对79%，P = 0.0003）。对于每周酒精摄入量大于140克的患者，该变量也具有显著性（P = 0.003）（调整后相对风险 = 5.5；95%CI = 1.3 - 24.5；P = 0.02）。多变量分析（Cox模型）表明，肝移植前戒酒6个月或更长时间是唯一的预测变量。
在这项对51例酒精性肝病移植患者的前瞻性研究中，肝移植前戒酒是肝移植后酒精复发的唯一预测因素。
