© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Clin Transplant 2014: 28: 1112–1120 DOI: 10.1111/ctr.12427

Clinical Transplantation

Negative outcomes after liver transplantation in patients with alcoholic liver disease beyond the fifth post-transplant year Graz t M, Lewandowski Z, Graz t K, Wronka KM, Krasnodez bski M, Barski K, Zborowska H, Patkowski W, Zieniewicz K, Krawczyk M. Negative outcomes after liver transplantation in patients with alcoholic liver disease beyond the fifth post-transplant year. Abstract: Although up to 50% of patients with alcoholic liver disease (ALD) resume alcohol consumption after liver transplantation (LT), numerous studies indicate that long-term results are not compromised. This study focused on evaluating the impact of ALD on outcomes up to and beyond the fifth year after LT. Among the 432 primary LT recipients included in this study, 97 underwent transplantation for ALD. Alcohol relapse rate at 10 yr was 33.5%, with younger recipient age being the only independent predictor (p = 0.019). Survival of patients with ALD (77.0%) was similar to those without (79.0%) up to the fifth posttransplant year (p = 0.655) but worse during the five subsequent years among the five-yr survivors (70.6% vs. 92.9%; p = 0.002). ALD was an independent risk factor for poorer survival beyond the fifth posttransplant year (p = 0.049), but not earlier (p = 0.717). Conversely, alcohol relapse increased the risk of death only during the first five posttransplant years (p = 0.039). There were no significant differences regarding graft failure incidence between ALD and non-ALD recipients up to the fifth post-transplant year (7.3% vs. 11.6%; p = 0.255) and beyond (12.9% vs. 5.0%; p = 0.126). In conclusion, pre-transplant diagnosis of ALD yields negative effects on post-transplant outcomes beyond the fifth post-transplant year, not attributable to recidivism.

Michał Graz ta, Zbigniew Lewandowskib, Karolina Graz ta, Karolina Maria Wronkaa, Maciej Krasnodez bskia, Krzysztof Barskia, Hanna Zborowskac, Waldemar Patkowskia, Krzysztof Zieniewicza and Marek Krawczyka a

Department of General, Transplant and Liver Surgery, Medical University of Warsaw, b Department of Epidemiology, Medical University of Warsaw and cDepartment of Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland Key words: alcoholic liver disease – alcoholism – liver transplantation – mortality – outcome assessment – recurrence Corresponding author: Michał Graz t, MD, PhD, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland. Tel.: +48 22 599 25 45; fax: +48 22 599 15 45; e-mail: [email protected] Conflicts of interest: The authors declare that there is no conflict of interests regarding the publication of this article. Accepted for publication 20 July 2014

Recently, alcohol use was identified as the fifth leading contributor to the global burden of diseases (1). The major differences observed between particular regions and countries in per capita alcohol consumption and patterns of alcohol use are related to the observed rates of cirrhosis-related mortality (2, 3). Nevertheless, end-stage liver disease in the course of alcoholic cirrhosis is one of the most common indications for liver transplantation, both in European countries and the USA (4, 5). Considering the limited number of available donors and the specific features of alcoholic

1112

liver disease (ALD), the selection of patients for transplantation continuously remains a subject of debate and controversies. Interestingly, not only the general public but also physicians tend to present negative attitudes toward liver transplantation in cases of ALD (6, 7). Alcoholic liver disease is associated with increased risk of developing several medical conditions that potentially alter long-term outcomes after transplantation. According to a recent report by Faure et al., excessive alcohol consumption in the post-transplant period is 5.8- to 17.4-fold more

Liver transplantation for ALD frequent in patients with ALD than in those with other indications for liver transplantation (8). As indicated by the results of that study, excessive drinking was associated with increased mortality beyond the fifth post-transplant year. Several previous reports also confirm that the negative impact of alcohol relapse is more marked if the follow-up period exceeds five yr (9, 10). Moreover, conditions such as diabetes and de novo malignancies are more common in patients after liver transplantation in the ALD population (11, 12). As diabetes increases the risk of post-transplant cardiovascular events and de novo tumors are associated with poor prognosis, cardiovascular and malignant causes of death are widely reported as main determinants of the mortality pattern in these patients (9, 11, 13–15). Outcomes of patients with alcoholic cirrhosis after liver transplantation are considered similar to those with other indications. Notably, numerous studies available in the transplant literature indicate non-inferiority of ALD to other indications in terms of patient survival (16–18). This observation was also supported by the results of one of our most recent studies (19). However, a significant proportion of the available results on survival comparisons are based upon observation periods of up to five yr. The incidence of cardiovascular events, diabetes, de novo malignancies, and the related risk of mortality steadily increase during the first 7–10 yr after liver transplantation (13, 20, 21). Therefore, the period between five and 10 post-transplant years may be crucial in comparisons of survival outcomes between patients with and without a history of ALD. Accordingly, the primary purpose of this study was to evaluate the impact of the pre-transplant diagnosis of ALD on outcomes of patients after liver transplantation both before and beyond the fifth post-transplant year with special focus on the relevance of alcohol relapse. Materials and methods

In general, 1266 liver transplantations were performed in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw between December 1994 and May 2013. The data on 432 of 586 recipients of primary liver transplantations performed between 1994 and 2007 were analyzed in this retrospective cohort study, after excluding patients with malignant tumors on postoperative explant pathology (n = 70), acute liver failure (n = 58), and cryptogenic cirrhosis (n = 26). Patients who underwent transplantation after 2007 were not included because

the follow-up period was

Negative outcomes after liver transplantation in patients with alcoholic liver disease beyond the fifth post-transplant year.

Although up to 50% of patients with alcoholic liver disease (ALD) resume alcohol consumption after liver transplantation (LT), numerous studies indica...
281KB Sizes 0 Downloads 3 Views