Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy.
Am J Transplant. 2010 Jan;10(1):138-48. doi: 10.1111/j.1600-6143.2009.02869.x. Epub 2009 Dec 1.
Alcohol-related liver disease (ALD) is one of the most common indications for liver transplantation (LT). Long-term outcome after LT for ALD versus other etiologies is still under debate. The aim of this study was to compare outcome after LT of patients with ALD, viral (VIR), and cryptogenic cirrhosis. Donor, graft and recipient ELTR variables were analysed in transplants for alcoholic and nonalcoholic cirrhosis (1988-2005) and were correlated with patient survival. Causes of death and/or graft failure were compared between groups. Nine thousand eight hundred eighty ALD, 10,943 VIR, 1478 ALD+VIR and 2410 cryptogenic (CRYP) liver transplants were evaluated. One, 3, 5 and 10 years graft survival rates after LT in ALD patients were 84%, 78%, 73%, 58%, significantly higher than in VIR and CRYP (p=0.04, p=0.05). By multivariate analysis, ALD+VIR (RR 1.14) and viral alone (RR 1.06) were significant risk factors for mortality. De novo tumors, cardiovascular and social causes were causes of death/graft failure in higher percentage in ALD groups versus other etiologies. LT for ALD cirrhosis has a favorable outcome, however, hepatitis C virus co-infection seems to eliminate this advantage. Screening for de novo tumors and prevention of cardiovascular complications are essential to provide better long-term results.
酒精性肝病（ALD）是肝移植（LT）最常见的适应证之一。ALD 与其他病因导致的 LT 后长期结果仍存在争议。本研究旨在比较 ALD、病毒性（VIR）和隐源性肝硬化患者 LT 后的结果。分析了 1988 年至 2005 年间进行的酒精性和非酒精性肝硬化（ALD 和非 ALD）肝移植中供体、移植物和受者 ELTR 变量，并与患者存活率相关。比较了各组之间的死亡原因和/或移植物失功。评估了 9880 例 ALD、10943 例 VIR、1478 例 ALD+VIR 和 2410 例隐源性（CRYP）肝移植。ALD 患者 LT 后 1、3、5 和 10 年的移植物存活率分别为 84%、78%、73%、58%，显著高于 VIR 和 CRYP（p=0.04，p=0.05）。多变量分析显示，ALD+VIR（RR1.14）和单纯病毒性（RR1.06）是死亡的显著危险因素。新发肿瘤、心血管和社会原因是 ALD 组与其他病因组死亡/移植物失功的更高比例的原因。ALD 肝硬化的 LT 有较好的结果，但丙型肝炎病毒合并感染似乎消除了这一优势。筛查新发肿瘤和预防心血管并发症对于提供更好的长期结果至关重要。
