Liver transplantation for alcoholic liver disease: a systematic review of psychosocial selection criteria.

AIMS

To examine the evidence base for psychosocial selection criteria for liver transplant candidates with alcoholic liver disease.

METHOD

Systematic review using three electronic databases supplemented by hand searches.

RESULTS

Out of 96 published studies, 22 were included. All but one were cohort design, most were retrospective, single centre, and small sample. Methodology varied considerably, such that meta-analysis was not feasible.

CONCLUSIONS

Social stability, no close relatives with an alcohol problem, older age, no repeated alcohol-treatment failures, good compliance with medical care, no current polydrug misuse, and no co-existing severe mental disorder have all been associated with future abstinence in more studies than not, in those that examined these variables. Duration of preoperative abstinence was a poor predictor. We recommend that, if predicting future abstinence is considered necessary by transplant teams, a standardized approach is agreed and deployed amongst transplant units, then audited and reviewed.