Gedaly Roberto, McHugh Patrick P, Johnston Thomas D, Jeon Hoonbae, Koch Alvaro, Clifford Timothy M, Ranjan Dinesh
Transplant Center, University of Kentucky College of Medicine, University of Kentucky Hospital, Lexington, KY 40536-0293, USA.
Transplantation. 2008 Oct 27;86(8):1090-5. doi: 10.1097/TP.0b013e3181872710.
Alcoholic liver disease (ALD) is a common indication for transplantation worldwide. This study identifies factors predicting posttransplant recidivism.
Clinical and laboratory data were reviewed. Uni- and multivariate analyses for survival and relapse to alcohol and illicit drugs were performed.
Between July 1995 and November 2007, 387 patients underwent liver transplantation at our institution. Of these, 147 patients (38%) were found to have ALD. Five patients (3.4%) were excluded because of perioperative mortality. Overall survival was 96.2%, 89.6%, and 84.4% at 1, 3, and 5 years, respectively, with a median follow-up of 41.2 months. Twenty-seven patients (19%) returned to alcohol after transplantation. By univariate analysis, depression was the only significant factor affecting survival (P=0.01), whereas posttransplant relapse to alcohol trended toward significance (P=0.059). Multivariate analysis showed both factors to be independently associated with poor survival (P=0.008 and 0.017, respectively). Factors associated with relapse included less than 12 months of abstinence before transplant (P=0.019) and participation in rehabilitation (P=0.026). Multivariate analysis showed pretransplant abstinence less than 12 months as the only independent factor (P=0.037) associated with alcohol relapse after transplantation. Twenty-five patients (17.2%) had documented drug use after transplantation. Drug abuse before transplantation was the only independent predictor of drug abuse after transplantation (P=0.017).
Excellent results can be obtained in patients undergoing liver transplantation for ALD, though depression and recidivism adversely impact survival. In our series, abstinence less than 12 months was associated with relapse to alcohol. Similarly, those with prior drug abuse are more likely to continue drug use after transplantation.
酒精性肝病（ALD）是全球范围内常见的移植指征。本研究旨在确定预测移植后复发的因素。
回顾临床和实验室数据。对生存以及酒精和非法药物复吸情况进行单因素和多因素分析。
1995年7月至2007年11月期间，我院有387例患者接受了肝移植。其中，147例患者（38%）被诊断为酒精性肝病。5例患者（3.4%）因围手术期死亡被排除。1年、3年和5年的总生存率分别为96.2%、89.6%和84.4%，中位随访时间为41.2个月。27例患者（19%）移植后再次饮酒。单因素分析显示，抑郁是影响生存的唯一显著因素（P=0.01），而移植后酒精复吸有显著趋势（P=0.059）。多因素分析显示这两个因素均与生存率低独立相关（分别为P=0.008和0.017）。与复吸相关的因素包括移植前戒酒时间少于12个月（P=0.019）和参与康复治疗（P=0.026）。多因素分析显示移植前戒酒时间少于12个月是移植后酒精复吸的唯一独立因素（P=0.037）。25例患者（17.2%）移植后有药物使用记录。移植前药物滥用是移植后药物滥用的唯一独立预测因素（P=0.017）。
酒精性肝病患者接受肝移植可获得良好效果，尽管抑郁和复吸会对生存产生不利影响。在我们的系列研究中，戒酒时间少于12个月与酒精复吸相关。同样，既往有药物滥用史的患者移植后更有可能继续使用药物。
