Russ Kirk B, Chen Nai-Wei, Kamath Patrick S, Shah Vijay H, Kuo Yong-Fang, Singal Ashwani K
Department of Internal Medicine, University of Alabama at Birmingham, 1720 2nd Ave S Birmingham, AL 35233, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochestor, MN 55905, USA.
Alcohol Alcohol. 2016 Nov;51(6):698-701. doi: 10.1093/alcalc/agw032. Epub 2016 Jun 6.
To assess alcohol use after liver transplantation (LT) and compare liver transplant recipients for alcoholic liver disease (ALD) with recipients for non-ALD causes.
National Institute of Diabetes and Digestive and Kidney Diseases liver transplant database stratified to ALD and non-ALD causes.
Among 488 LT recipients reporting pre-transplant alcohol use (147 ALD), proportion of LT recipients reporting alcohol use was similar comparing ALD and non-ALD transplants (25.4% vs. 27.2%; P = 0.56). Among ALD transplants, of 31 with alcohol use, 23 (74%) relapsed at ≥2 year, 25 (80%) reported intermittent drinking and 4 (13%) reported heavy drinking. Among Non-ALD recipients, alcohol use was equally distributed to within 2, 2-5 and after 5 years of LT with 82% reporting intermittent drinking and 9% heavy drinking. Patients with pre-transplant drinking of >20 years and abstinence duration of <2 years were over 2.5-fold likely to report post-transplant alcohol use compared to drinking of >20 years and abstinence of >2 years, 2.56 [95% CI: 1.41-4.67]. Etiology (ALD vs. non-ALD) did not predict post-transplant alcohol use. Of 139 ALD patients with follow-up biopsy data, 13 (7 with post-transplant alcohol use) had steatohepatitis. Histology on 319 non-ALD recipients showed recurrent disease in 91, none due to alcohol. Overall survival was similar between drinkers and abstainers (71% vs. 66%; P = 0.35). Recurrent ALD was cause of death in one ALD and none of non-ALD patients.
Alcohol use after LT is independent of LT indication. Patients with non-ALD etiology should be carefully screened for alcohol use prior to LT to identify those at risk for post-LT alcohol use.
评估肝移植（LT）后的酒精使用情况，并比较酒精性肝病（ALD）肝移植受者与非ALD病因的肝移植受者。
美国国立糖尿病、消化和肾脏疾病研究所的肝移植数据库按ALD和非ALD病因进行分层。
在488名报告移植前饮酒的LT受者中（147名ALD患者），报告饮酒的LT受者比例在ALD和非ALD移植受者中相似（25.4%对27.2%；P = 0.56）。在ALD移植受者中，31名饮酒者中，23名（74%）在≥2年后复发，25名（80%）报告间歇性饮酒，4名（13%）报告大量饮酒。在非ALD受者中，酒精使用在LT后2年内、2 - 5年内和5年后分布均匀，82%报告间歇性饮酒，9%报告大量饮酒。移植前饮酒>20年且戒酒时间<2年的患者与饮酒>20年且戒酒>2年的患者相比，移植后报告饮酒的可能性高出2.5倍以上，为2.56[95%置信区间：1.41 - 4.67]。病因（ALD与非ALD）不能预测移植后酒精使用情况。在139名有随访活检数据的ALD患者中，13名（7名移植后饮酒）患有脂肪性肝炎。319名非ALD受者的组织学检查显示91名有疾病复发，均非由酒精引起。饮酒者和戒酒者的总生存率相似（71%对66%；P = 0.35）。一名ALD患者因复发性ALD死亡，非ALD患者无此情况。
LT后的酒精使用与LT指征无关。对于非ALD病因的患者，在LT前应仔细筛查酒精使用情况，以识别有LT后酒精使用风险的患者。
