Berlakovich G A, Steininger R, Herbst F, Barlan M, Mittlböck M, Mühlbacher F
Department of Transplant Surgery, University of Vienna, Austria.
Transplantation. 1994 Sep 15;58(5):560-5. doi: 10.1097/00007890-199409150-00006.
Many transplant centers are reluctant to accept alcoholic patients for OLT because of their supposed potential for alcoholic recidivism and poor compliance with the required immunosuppressive regimen, both of which result in graft failure. Only inconclusive data related to these arguments are available. From May 1982 to January 1993, 58 patients received OLT at our institution for end-stage cirrhosis, where alcohol was the only toxic component. The indication for OLT in these patients was considered with particular attention to recidivism and compliance. Overall survival in this group was 71% and 63% at 1 and 5 years, respectively, with an average survival time of 78 months. Actuarial survival of patients transplanted since January 1989 (n = 37) was 86% and 83% at 1 and 2 years (average survival 42 months). Nonfatal clinical endpoints were analyzed in those patients surviving at least 3 months (n = 44). Return to alcohol abuse has been documented in 14 persons at routine short-term outpatient checkups. The estimated risk for alcoholic recidivism amounts to 31%, with a median follow-up of 33 months. Compliance with immunosuppressive regimen was expressed as a dependent value of acute rejection episodes (0.3 per patient, median follow-up 33 months), chronic rejection (occurred in none of the patients), and measurements of CsA HPLC blood trough level (92.2% within the target range). The preversus postoperative improvement of employment, marital, and social status after OLT showed a statistically significant difference. Unwillingness to offer OLT to individuals with alcoholic liver disease because of failure to demonstrate 100% long-term abstinence appears difficult to defend in the face of good results in survival, compliance, and social rehabilitation.
许多移植中心不愿接受酒精性肝病患者进行肝移植，因为他们认为这些患者有酒精复饮的潜在风险，且对所需的免疫抑制方案依从性差，这两者都会导致移植失败。但关于这些观点的相关数据并不确凿。1982年5月至1993年1月，我院有58例患者因终末期肝硬化接受肝移植，酒精是唯一的毒性成分。在考虑这些患者的肝移植指征时，特别关注了复饮和依从性问题。该组患者1年和5年的总体生存率分别为71%和63%，平均生存时间为78个月。1989年1月以来接受移植的患者（n = 37）1年和2年的精算生存率分别为86%和83%（平均生存42个月）。对至少存活3个月的患者（n = 44）的非致命临床终点进行了分析。在常规短期门诊检查中，有14人被记录到再次酗酒。酒精复饮的估计风险为31%，中位随访时间为33个月。免疫抑制方案的依从性表现为急性排斥反应发作的相关值（每位患者0.3次，中位随访33个月）、慢性排斥反应（无患者发生）以及环孢素高效液相色谱血药谷浓度测量值（92.2%在目标范围内）。肝移植术后就业、婚姻和社会地位的术前与术后改善显示出统计学上的显著差异。面对在生存、依从性和社会康复方面的良好结果，因未能证明100%长期戒酒而不愿为酒精性肝病患者提供肝移植的做法似乎难以自圆其说。
