Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Psychiatry, Institute of Liver and Biliary Sciences, New Delhi, India.
J Hepatobiliary Pancreat Sci. 2023 Aug;30(8):1015-1024. doi: 10.1002/jhbp.1325. Epub 2023 Mar 15.
Alcohol relapse after liver transplantation has a negative impact on outcomes. There is limited data on its burden, the predictors, and impact following live donor liver transplantation (LDLT).
A single-center observational study was carried out between July 2011 and March 2021 for patients undergoing LDLT for alcohol associated liver disease (ALD). The incidence, predictors of alcohol relapse, and post-transplant outcomes were assessed.
Altogether 720 LDLT were performed during the study period, 203 (28.19%) for ALD. The overall relapse rate was 9.85% (n = 20) with a median follow-up of 52 months (range, 12-140 months). Sustained harmful alcohol use was seen in 4 (1.97%). On multivariate analysis, pre-LT relapse (P = .001), duration of abstinence period (P = .007), daily intake of alcohol (P = .001), absence of life partner (P = .021), concurrent tobacco abuse before transplant (P = .001), the donation from second-degree relative (P = .003) and poor compliance with medications (P = .001) were identified as predictors for relapse. Alcohol relapse was associated with the risk of graft rejection (HR 4.54, 95% CI: 1.751-11.80, P = .002).
Our results show that the overall incidence of relapse and rate of harmful drinking following LDLT is low. Donation from spouse and first degree relative was protective. History of daily intake, prior relapse, shorter pretransplant abstinence duration and lack of family support significantly predicted relapse.
肝移植后酒精复饮对结局有负面影响。关于其负担、预测因素以及活体肝移植（LDLT）后的影响，数据有限。
对 2011 年 7 月至 2021 年 3 月期间因酒精相关性肝病（ALD）接受 LDLT 的患者进行了一项单中心观察性研究。评估了酒精复饮的发生率、预测因素和移植后结局。
研究期间共进行了 720 例 LDLT，其中 203 例（28.19%）为 ALD。总体复饮率为 9.85%（n=20），中位随访时间为 52 个月（范围，12-140 个月）。持续有害饮酒者有 4 例（1.97%）。多变量分析显示，LT 前复饮（P=0.001）、戒断期持续时间（P=0.007）、每日饮酒量（P=0.001）、无生活伴侣（P=0.021）、移植前同时滥用烟草（P=0.001）、来自二级亲属的供肝（P=0.003）和药物依从性差（P=0.001）是复饮的预测因素。酒精复饮与移植物排斥风险相关（HR 4.54，95%CI：1.751-11.80，P=0.002）。
我们的研究结果表明，LDLT 后复饮和有害饮酒的总体发生率较低。来自配偶和一级亲属的供肝具有保护作用。每日摄入史、既往复饮、LT 前戒断时间较短以及缺乏家庭支持显著预测了复饮。
