Kollmann Dagmar, Rasoul-Rockenschaub Susanne, Steiner Irene, Freundorfer Edith, Györi Georg Philipp, Silberhumer Gerd, Soliman Thomas, Berlakovich Gabriela Andrea
Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria.
Transpl Int. 2016 May;29(5):559-67. doi: 10.1111/tri.12756. Epub 2016 Mar 1.
Alcoholic liver disease (ALD) is the second most common indication for liver transplantation (LT). The utility of fixed intervals of abstinence prior to listing is still a matter of discussion. Furthermore, post-LT long-term observation is challenging, and biomarkers as carbohydrate-deficient transferrin (CDT) may help to identify alcohol relapse. We retrospectively analyzed data from patients receiving LT for ALD from 1996 to 2012. A defined period of alcohol abstinence prior to listing was not a precondition, and abstinence was evaluated using structured psychological interviews. A total of 382 patients received LT for ALD as main (n = 290) or secondary (n = 92) indication; median follow-up was 73 months (0-213). One- and five-year patient survival and graft survival rates were 82% and 69%, and 80% and 67%, respectively. A total of 62 patients (16%) experienced alcohol relapse. Alcohol relapse did not have a statistically significant effect on patient survival (P = 0.10). Post-transplant CDT measurements showed a sensitivity and specificity of 84% and 85%, respectively. In conclusion, this large single-center analysis showed good post-transplant long-term results in patients with ALD when applying structured psychological interviews before listing. Relapse rates were lower than those reported in the literature despite using a strict definition of alcohol relapse. Furthermore, post-LT CDT measurement proved to be a useful supplementary tool for detecting alcohol relapse.
酒精性肝病（ALD）是肝移植（LT）的第二大常见适应症。在列入移植名单之前设定固定的戒酒期的效用仍存在争议。此外，肝移植后的长期观察具有挑战性，而诸如缺糖转铁蛋白（CDT）等生物标志物可能有助于识别酒精复饮情况。我们回顾性分析了1996年至2012年因ALD接受肝移植患者的数据。列入移植名单之前设定明确的戒酒期并非前提条件，而是通过结构化心理访谈来评估戒酒情况。共有382例患者因ALD作为主要适应症（n = 290）或次要适应症（n = 92）接受了肝移植；中位随访时间为73个月（0 - 213个月）。1年和5年的患者生存率及移植物生存率分别为82%和69%，以及80%和67%。共有62例患者（16%）出现酒精复饮。酒精复饮对患者生存率没有统计学上的显著影响（P = 0.10）。移植后CDT测量的敏感性和特异性分别为84%和85%。总之，这项大型单中心分析表明，在列入移植名单之前应用结构化心理访谈时，ALD患者移植后的长期结果良好。尽管对酒精复饮采用了严格定义，但复饮率低于文献报道。此外，肝移植后CDT测量被证明是检测酒精复饮的有用辅助工具。
