Björnsson Einar, Olsson Janet, Rydell Annika, Fredriksson Kerstin, Eriksson Cathrina, Sjöberg Clas, Olausson Michael, Bäckman Lars, Castedal Maria, Friman Styrbjörn
Department of Internal Medicine, Section of Gastroenterology and Hepatology, SE-413 45 Gothenburg, Sweden.
Scand J Gastroenterol. 2005 Feb;40(2):206-16. doi: 10.1080/00365520410009591.
No systematic evaluation has been performed previously in the Scandinavian countries on patients transplanted for alcoholic liver disease (ALD). Data are limited on the impact of structured management of the alcohol problem on the risk of recidivism following transplantation in ALD.
A total of 103 ALD patients were compared with a control group of patients with non-alcoholic liver disease (NALD). The recidivism rates for ALD patients transplanted between 1988 and 1997 as well as after 1998 (institution of structured management) were compared.
The median follow-up was 31 (6-60) months in the ALD group and 37 (12-63) months in the control group (NS). The overall survival rates at 1- and 5 years were, respectively, 81% and 69% for the ALD group and 87% and 83% for the non-alcoholic group. The proportion of patients with Child-Pugh C (75%) was higher in ALD patients than in NALD patients (44%) (p<0.01). Thirty-two (33%) ALD patients resumed taking some alcohol after transplantation; 17 patients (18%) were heavy drinkers. A multivariate analysis showed that: sex, age, marital and employment status, benzodiazepine use and a history of illicit drug abuse did not predict the risk of alcohol relapse post-Tx. Nineteen out of 40 (48%) patients transplanted before the start of structured management had resumed alcohol but 13 (22%) out of 58 after this intervention (p=0.002).
ALD is a good indication for liver transplantation, with similar results in the ALD patients. Structured management of the alcohol problem before and after transplantation is important in minimizing the risk of recidivism.
此前斯堪的纳维亚国家尚未对因酒精性肝病（ALD）接受移植的患者进行系统评估。关于酒精问题的结构化管理对ALD患者移植后复发风险的影响，数据有限。
共将103例ALD患者与一组非酒精性肝病（NALD）患者作为对照组进行比较。比较了1988年至1997年以及1998年之后（实施结构化管理后）接受移植的ALD患者的复发率。
ALD组的中位随访时间为31（6 - 60）个月，对照组为37（12 - 63）个月（无显著差异）。ALD组1年和5年的总生存率分别为81%和69%，非酒精性组为87%和83%。Child-Pugh C级患者的比例在ALD患者中（75%）高于NALD患者（44%）（p<0.01）。32例（33%）ALD患者移植后恢复饮酒；17例患者（18%）为重度饮酒者。多因素分析显示：性别、年龄、婚姻和就业状况、苯二氮䓬类药物使用情况以及非法药物滥用史均不能预测移植后酒精复发风险。在结构化管理开始前接受移植的40例患者中有19例（48%）恢复饮酒，但在此干预后58例中有13例（22%）恢复饮酒（p = 0.002）。
ALD是肝移植的良好适应证，ALD患者的结果相似。移植前后对酒精问题进行结构化管理对于将复发风险降至最低很重要。
