Wigg Alan J, Mangira Dileep, Chen John W, Woodman Richard W
South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Intern Med J. 2017 Jun;47(6):656-663. doi: 10.1111/imj.13431.
Limited studies of patient survival and alcoholic relapse following transplantation for alcoholic liver disease have been described in Australian populations.
To describe these outcomes in an Australian population, to determine the association between harmful alcoholic relapse and patient survival, and to examine pre-transplant variables associated with harmful relapse.
Single centre, retrospective review of consecutive patients transplanted at the South Australian Liver Transplant Unit. Relapse was identified by an independent investigator using case note review and confidential patient questionnaire.
A total of 87 patients (median age 52 years, 84% male, median Model for End-Stage Liver Disease (MELD) score 18) was included in the study with a median follow-up time of 50 months. The 1-, 3- and 5-year survival of patients was 93.1, 87.4 and 82.0% respectively. Two deaths were directly attributable to graft failure due to alcohol. Fourteen (16%) patients fulfilled criteria for harmful relapse and 18 (21%) patients experienced any form of relapse to alcohol. Harmful relapse was associated with increased mortality (hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.1-9.7, P = 0.041). Only two factors were independently associated with harmful relapse on multivariate analysis; prior alcohol rehabilitation (HR 8.4, 95% CI 2.5-28.4, P = 0.001) and single versus married status (HR 0.09, 95% CI 0.02-1.2, P = 0.019).
Good patient survival outcomes were seen for this South Australian population. Harmful alcohol relapse occurs in a minority of patients and rarely results in direct graft loss. Modifiable pre-transplant factors that predict harmful relapse were not identified.
澳大利亚人群中关于酒精性肝病移植后患者生存率和酒精复发情况的研究有限。
描述澳大利亚人群中的这些结果，确定有害酒精复发与患者生存率之间的关联，并研究与有害复发相关的移植前变量。
对南澳大利亚肝移植单位连续进行移植的患者进行单中心回顾性研究。由一名独立研究人员通过病历审查和保密患者问卷确定复发情况。
共有87名患者（中位年龄52岁，84%为男性，终末期肝病模型（MELD）评分中位数为18）纳入研究，中位随访时间为50个月。患者的1年、3年和5年生存率分别为93.1%、87.4%和82.0%。两例死亡直接归因于酒精导致的移植物衰竭。14名（16%）患者符合有害复发标准，18名（21%）患者经历了任何形式的酒精复发。有害复发与死亡率增加相关（风险比（HR）3.2，95%置信区间（CI）1.1 - 9.7，P = 0.041）。多因素分析中，仅有两个因素与有害复发独立相关；既往酒精康复治疗（HR 8.4，95% CI 2.5 - 28.4，P = 0.001）以及单身与已婚状态（HR 0.09，95% CI 0.02 - 1.2，P = 0.019）。
该南澳大利亚人群患者生存率良好。少数患者出现有害酒精复发，且很少导致直接的移植物丢失。未发现可预测有害复发的移植前可改变因素。
