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Incidence of and Risk Factors for Alcohol Relapse After Liver Transplantation for Alcoholic Liver Disease: Comparison Between Deceased Donor and Living Donor Liver Transplantation

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

There are controversies over whether patients with alcohol-related liver disease (ALD) should follow the “6-month abstinence rule” before undergoing liver transplantation (LT), especially in case of living donor LT (LDLT). We analyzed the risk of alcohol relapse among ALD patients who received LT according to donor types and abstinence period before LT.

Methods

A total of 129 patients (mean 50.7 ± 9.2 years, male 78.3%) who underwent LT between January 2000 and July 2017 for ALD at Samsung Medical Center, Seoul, Korea, were analyzed. Alcohol relapse was defined as any use of alcohol after LT.

Results

The alcohol relapse rate was lower in LDLT recipients compared with that in DDLT recipients (13.9% vs. 31.7% at 3 years, P = 0.013). DDLT recipient, short abstinence period (< 6 months), and current smoking status were factors associated with alcohol relapse. The alcohol relapse rate was highest (54.5% at 3 years) for current smokers without 6-month sobriety who received DDLT, and it was lowest for never/ex-smoker with 6-month sobriety who received LDLT (4.3% at 3 years). For LDLT recipients, the alcohol relapse rate was not different according to abstinence period (17.7% vs. 11.6% at 3 years for short abstinent period < 3 months vs. ≥ 3 months, P = 0.92), but it was higher for current smokers compared with that for non/ex-smokers (22.4% vs. 5.8% at 3 years, P = 0.05).

Conclusion

When considering LDLT for ALD, sobriety period may not be an absolute contraindication as abstinence period showed a weak association with alcohol relapse. Smokers need careful attention for alcohol relapse.

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Abbreviations

ALD:

Alcohol-related liver disease

DDLT:

Deceased donor liver transplantation

HCC:

Hepatocellular carcinoma

LC:

Liver cirrhosis

LDLT:

Living donor liver transplantation

LT:

Liver transplantation

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Authorship

DHS and GSC conceived and conceptualized the study, participated in research design, analyzed the data, and performed critical revision of drafts.

HGC and DHS performed statistical analysis, and wrote and edited drafts of the article.

GSC, JMK, and JWJ helped acquire data, and guided statistical analysis.

All authors participated in the performance of the research and gave final approval of the manuscript.

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Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Hye Gyo Chung, Dong Hyun Sinn & Wonseok Kang

  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Gyu-Seong Choi, Jong Man Kim & Jae-Won Joh

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  1. Hye Gyo Chung
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  2. Dong Hyun Sinn
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Correspondence to Dong Hyun Sinn or Gyu-Seong Choi.

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Chung, H.G., Sinn, D.H., Kang, W. et al. Incidence of and Risk Factors for Alcohol Relapse After Liver Transplantation for Alcoholic Liver Disease: Comparison Between Deceased Donor and Living Donor Liver Transplantation. J Gastrointest Surg 25, 672–680 (2021). https://doi.org/10.1007/s11605-020-04540-7

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