Liver Transplantation in Alcoholic Patients: Impact of an Alcohol Addiction Unit Within a Liver Transplant Center

Background: Many concerns about liver transplantation in alcoholic patients are related to the risk\r\nof alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit (AAU) was formed within the\r\nliver transplant center for the management of alcoholic patients affected by end-stage liver disease and\r\nincluded in the waiting list for transplantation. We evaluated retrospectively the impact of the AAU on\r\nalcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration\r\nof alcohol abstinence before transplant was evaluated as well.\r\nMethods: Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation.\r\nClinical evaluation and management of alcohol use in these patients was provided by psychiatrists with\r\nexpertise in addiction medicine not affiliated to the liver transplant center before 2002 (n = 37; group\r\nA), or by the clinical staff of the AAU within the liver transplant center starting from 2002 (n = 55;\r\ngroup B).\r\nResults: Group B, as compared with group A, showed a significantly lower prevalence of alcohol\r\nrecidivism (16.4 vs. 35.1%; p = 0.038) and a significantly lower mortality (14.5 vs. 37.8%; p = 0.01).\r\nFurthermore, an analysis of group B patients with either 6 or <6 months of alcohol abstinence before\r\ntransplantation showed no difference in the rate of alcohol recidivism (21.1 vs. 15.4%; p = ns).\r\nConclusions: The presence of an AAU within a liver transplant center reduces the risk of alcohol\r\nrecidivism after transplantation. A pretransplant abstinence period <6 months might be considered, at\r\nleast in selected patients managed by an AAU.