Do Patients Return to Drinking After Liver Transplantation for Alcoholic Liver Disease?

Patients with a liver transplant for alcoholic liver disease are advised to abstain permanently from alcohol. To measure the recurrence of alcohol use after liver transplantation, researchers assessed 167 liver recipients every 3 months during the first post-transplant year and then every 6 months for 4 years thereafter. At routine aftercare appointments, subjects received recommendations for complete abstinence and additional counseling if they had returned to drinking. The majority of subjects were white and male, had alcohol dependence, and were sober for an average of 40 months before transplantation.

• During the first year after transplantation, 22% of subjects had at least 1 drink, 10% had at least 1 heavy drinking episode,* and 5% returned to frequent drinking.** By the fifth post-transplant year, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.
• In multivariable models, the length of pre-transplant sobriety was associated with a significantly lower risk of first alcohol use (hazard ratio [HR] 0.7) and first heavy drinking episode (HR 0.7). Alcohol dependence and pre-transplant depression were associated with a significantly higher risk of alcohol use (HRs 2.3 and 1.7, respectively).

Comments:

This study shows that although the majority of liver recipients do not drink heavily, a substantial proportion returns to some alcohol use after transplantation for alcoholic liver disease. The findings highlight the need to develop improved supportive strategies, particularly those that increase the length of pre-transplant sobriety, to prevent post-transplant alcohol use.

Kevin L. Kraemer, MD, MSc

Reference:

DiMartini A, Day N, Dew MA, et al. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease. Liver Transpl. 2006;12(5):813–820.