Rogal Shari, Shenai Neeta, Kruckenberg Katherine, Rosenberger Emily, Dew Mary Amanda, DiMartini Andrea
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA.
Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Alcohol Alcohol. 2018 Mar 1;53(2):157-165. doi: 10.1093/alcalc/agx100.
Liver transplantation (LT) for alcoholic liver disease (ALD) remains controversial yet following transplantation outcomes for patients with this disease are generally similar to patients transplanted for other types of liver diseases.
In this review, we cover critical literature of ALD LT including established and recent findings of medical and psychosocial outcomes for ALD patients and compare their outcomes to other liver transplant recipients where evidence exists.
Overall medical and psychosocial outcomes for ALD LT recipients compare favorably to patients transplanted for other types of liver diseases. While alcohol relapse occurs following transplant, the rates of return to heavy alcohol use, especially at amounts that are health harmful, are low at ~20%-substantially under rates of relapse for non-transplant patients with alcohol use disorders. However, ALD LT recipients are more likely to be smokers and experience causes of death different than other LT recipients with cardiovascular and malignancies being more common. Depression is one of the more common mental health disorders experienced by ALD LT recipients and is especially important to consider due to increasing evidence of its negative impact on post-transplant survival. In general, ALD LT recipients' quality of life is as good as recipients transplanted for other types of liver disease. Post-LT re-employment and social reintegration are also comparable.
Early identification may improve outcomes with the first post-transplant year being an important time for close monitoring. Additionally, efforts to identify and treat tobacco use and depression may also improve overall outcomes in this specific population.
In this review, we cover medical and psychosocial outcomes for ALD patients and compare their outcomes to other liver transplant recipients. While alcohol relapse occurs following transplant, the rates of return to heavy alcohol use, especially at amounts that are health harmful, are low at ~20%.
酒精性肝病（ALD）患者的肝移植（LT）仍存在争议，然而该疾病患者移植后的总体结局通常与其他类型肝病患者移植后的结局相似。
在本综述中，我们涵盖了ALD肝移植的关键文献，包括ALD患者医学和心理社会结局的既定及最新研究结果，并在有证据的情况下将其结局与其他肝移植受者的结局进行比较。
ALD肝移植受者的总体医学和心理社会结局优于其他类型肝病的移植患者。虽然移植后会出现酒精复饮情况，但恢复大量饮酒（尤其是达到有害健康程度）的比例较低，约为20%，远低于患有酒精使用障碍的非移植患者的复饮率。然而，ALD肝移植受者更有可能是吸烟者，且经历的死亡原因与其他肝移植受者不同，心血管疾病和恶性肿瘤更为常见。抑郁症是ALD肝移植受者较常见的心理健康障碍之一，鉴于越来越多的证据表明其对移植后生存有负面影响，尤其值得关注。总体而言，ALD肝移植受者的生活质量与其他类型肝病移植受者相当。肝移植后再就业和社会重新融入情况也相近。
早期识别可能改善结局，移植后的第一年是密切监测的重要时期。此外，识别和治疗吸烟及抑郁症的努力也可能改善这一特定人群的总体结局。
在本综述中，我们涵盖了ALD患者的医学和心理社会结局，并将其结局与其他肝移植受者进行比较。虽然移植后会出现酒精复饮，但恢复大量饮酒（尤其是达到有害健康程度）的比例较低，约为20%。
