Kumar S, Stauber R E, Gavaler J S, Basista M H, Dindzans V J, Schade R R, Rabinovitz M, Tarter R E, Gordon R, Starzl T E
Department of Epidemiology, University of Pittsburgh, School of Medicine, PA 15261.
Hepatology. 1990 Feb;11(2):159-64. doi: 10.1002/hep.1840110202.
Alcohol abuse is the most common cause of end-stage liver disease in the United States, but many transplant centers are unwilling to accept alcoholic patients because of their supposed potential for recidivism, poor compliance with the required immunosuppression regimen and resulting failure of the allograft. There is also concern that alcohol-induced injury in other organs will preclude a good result. From July 1, 1982, to April 30, 1988, 73 patients received orthotopic liver transplants at the University of Pittsburgh for end-stage alcoholic liver disease. Fifty-two (71%) of these were alive at 25 +/- 9 mo (mean +/- S.D.) after transplantation, when a phone survey of these patients, their wives/husbands, and their physicians was performed to evaluate their subsequent use of alcohol, current medical condition and employment. Data obtained were compared with those for nonalcoholic patients selected as transplant controls. The recidivism rate has been 11.5%, with most patients drinking only socially. Fifty-four percent of the survivors are employed, 21% classify themselves as homemakers and only 11 (21%) are unable to work. Twenty-one patients died after transplantation; the most frequent cause of death was sepsis (43%), and intraoperative death was the next most common cause (28.6%). These data demonstrate that alcoholic patients can be transplanted successfully and achieve good health not significantly different from that of individuals transplanted for other causes. Thus orthotopic liver transplantation is a therapeutic option that should be considered for individuals with end-stage alcoholic liver disease who desire such therapy.
在美国，酒精滥用是终末期肝病最常见的病因，但许多移植中心不愿接收酗酒患者，因为他们被认为有复发的可能性，对所需免疫抑制方案的依从性差，进而导致同种异体移植物功能衰竭。还有人担心酒精对其他器官造成的损伤会影响移植效果。从1982年7月1日至1988年4月30日，匹兹堡大学为73例终末期酒精性肝病患者进行了原位肝移植。其中52例（71%）在移植后25±9个月（平均±标准差）存活，当时对这些患者、他们的妻子/丈夫及其医生进行了电话调查，以评估他们随后的饮酒情况、当前的健康状况和就业情况。将获得的数据与作为移植对照的非酒精性患者的数据进行比较。复发率为11.5%，大多数患者只是偶尔饮酒。54%的幸存者有工作，21%将自己归类为家庭主妇，只有11例（21%）无法工作。21例患者在移植后死亡；最常见的死亡原因是败血症（43%），其次是术中死亡（28.6%）。这些数据表明，酗酒患者能够成功接受移植并获得良好的健康状况，与因其他原因接受移植的个体相比没有显著差异。因此，原位肝移植是一种治疗选择，对于渴望接受这种治疗的终末期酒精性肝病患者应予以考虑。
