Fábrega E, Crespo J, Casafont F, De las Heras G, de la Peña J, Pons-Romero F
Gastroenterology and Hepatology Unit, University Hospital Marqués de Valdecilla, Faculty of Medicine, Santander, Spain.
J Clin Gastroenterol. 1998 Apr;26(3):204-6. doi: 10.1097/00004836-199804000-00011.
Liver transplantation (LT) for alcoholic cirrhosis remains controversial. This controversy surrounding LT in alcoholics focuses on the risk of alcohol recidivism and on potential noncompliance with the immunosuppressive regimen, both of which result in graft failure. Our study examined alcohol recidivism after LT by measuring alcohol in urine and its repercussion on the allograft. Forty-four consecutive alcoholic patients and a comparison group of 17 patients receiving LT were included in this study and followed up for a mean of 39.5 +/- 19.6 months. Seven percent (3 of 44) of patients with alcoholic liver disease and 0% of patients in the comparison group admitted to having used alcohol after LT. Alcohol in urine, however, was detected in 18% (8 of 44) of the alcoholic group; therefore the true recidivism rate was higher than the rate admitted. All patients in both groups were compliant with the medications, because the cyclosporine levels were within the therapeutic range in all. On histologic examination the only alcohol-induced lesion found in three of the eight recidivistic patients was steatosis. Therefore, although alcoholic recidivism occurs, it does not seem to affect compliance to treatment profoundly or to compromise graft function. Therefore, LT seems justified for end-stage alcoholic cirrhosis.
酒精性肝硬化的肝移植（LT）仍存在争议。围绕酒精性肝病患者肝移植的争议焦点在于酒精复饮风险以及潜在的免疫抑制方案依从性问题，这两者都会导致移植失败。我们的研究通过检测尿液中的酒精及其对同种异体移植物的影响来研究肝移植后的酒精复饮情况。本研究纳入了44例连续的酒精性肝病患者以及17例接受肝移植的对照患者，并对其进行了平均39.5±19.6个月的随访。酒精性肝病患者中有7%（44例中的3例）以及对照组患者中有0%承认在肝移植后饮酒。然而，酒精性肝病组中有18%（44例中的8例）检测到尿液中含有酒精；因此实际复饮率高于报告率。两组所有患者均依从药物治疗，因为所有患者的环孢素水平均在治疗范围内。组织学检查发现，8例复饮患者中有3例仅出现酒精性脂肪变性。因此，尽管存在酒精复饮情况，但似乎并未严重影响治疗依从性或损害移植物功能。因此，对于终末期酒精性肝硬化患者，肝移植似乎是合理的。
