When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?
When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?作者机构：Facultad de Medicina Universidad Popular Autonoma del Estado de Puebla Puebla Puebla 72410 Mexico Foundation Surgical Hospital of Houston Houston TX 77054 United States Texas A and M University Corpus Christi TX 78405 United States Pulmonary Associates Corpus Christi TX 78336 United States
出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)
年 卷 期：2016年第22卷第20期
页 面：4789-4793页
核心收录：
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
主 题：Liver transplantation Alcoholic liver disease Alcoholic cirrhosis Selection criteria Relapses
摘 要：Alcoholic liver disease(ALD) is one of the most common indications for liver transplantation(LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a self-inflicted disease. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ.
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