Medical Grounds Alcoholics historically have been considered unsuitable for liver transplantation because of their presumed high risk of relapse to excessive drinking after transplantation.
Alcoholic cirrhosis of the liver, which is characterized by severe scarring due to the heavy use of alcohol, is the major cause of end-stage liver disease. For those afflicted with cirrhosis, a liver transplant often offers the only possibility for survival.
The 1-year and 5-year actuarial survival rates following liver transplantation for patients with alcoholic liver dis- ease are 82% and 68%, respectively, in the United States and 85% and 70%, respectively, in Europe.
To be considered for a liver transplant, you should not smoke or take illegal drugs, and should have stopped drinking alcohol for at least 6 months.
You may be disqualified from having a liver transplant if you have: Current alcohol or drug abuse problems. Uncontrolled infection that will not go away with a transplant. Metastatic cancer or bile duct cancer.
Advancing age, sarcopenia, acute on chronic liver failure, and non-liver-related medical co-morbidities are common conditions that arise while on the wait-list that can render a patient too sick for transplant.
The most common cause of chronic liver failure is scarring of the liver (cirrhosis). When cirrhosis occurs, scar tissue replaces typical liver tissue and the liver doesn't function properly. Cirrhosis is the most frequent reason for a liver transplant.
The controversy peaked in the 1990s when celebrities with drinking problems — Larry Hagman, David Crosby and Mickey Mantle — got liver transplants. More recently, British soccer star George Best received a new liver in 2002, started drinking again and died three years later.
The mean age was 52.2 ± 9.0 years. Most LT were performed on patients in their 50s (n = 4290, 45.6%) and 0.9% (n = 84) of the LT was performed on patients older 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%.
People needing liver or heart transplants often need to wait nine or more months. Recipients are assessed for compatibility to the donor (not just blood type, but for six different tissue antigen subtypes as well as general body size – e.g. putting an adult heart into a small child is not possible).
Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse.
Some alcoholics may suffer seriously from the many physical and psychological symptoms of alcoholism, but escape serious liver damage. Alcoholic cirrhosis is found among alcoholics about 10 to 25 percent of the time.
Risks of a liver transplant
More than 9 out of every 10 people are still alive after 1 year, around 8 in every 10 people live at least 5 years, and many people live for up to 20 years or more.
Survival rates of 70% are reported both at 2 years and at 10 years. Alcoholic hepatitis is a precirrhotic lesion; progression to cirrhosis is observed more commonly in women, in individuals with severe disease and in those who continue to drink.
It's generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and doesn't stop drinking has a less than 50% chance of living for at least 5 more years.
Heavy drinkers and alcoholics may progress from fatty liver to alcoholic hepatitis to cirrhosis, and it is estimated that 10 percent to 15 percent of alcoholics will develop cirrhosis.
Alcohol Related Cirrhosis: The most serious form of ALD, it occurs when the entire liver is scarred, causing the liver to shrink and harden. This can lead to liver failure. Usually the damage cannot be reversed. Between 10 to 20 percent of heavy drinkers develop cirrhosis typically after 10 or more years of drinking.
In summary, the leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Older age, diabetes, and renal insufficiency identified patients at highest risk of poor survival overall.
Patients with compensated cirrhosis have a median survival that may extend beyond 12 years. Patients with decompensated cirrhosis have a worse prognosis than do those with compensated cirrhosis; the average survival without transplantation is approximately two years [13,14].
When a patient's liver disease reaches cirrhosis, a stage when the liver damage can no longer be reversed, it becomes a terminal diagnosis. Unlike most terminal illnesses, a cure may be available for some patients through a liver transplant.
The chance to be transplanted at two years from listing was 65% and the risk of death was 17%. Patients with metabolic liver disease had the highest chance of undergoing liver transplantation.
People with cirrhosis in Class A have the best prognosis, with a life expectancy of 15 to 20 years. People with cirrhosis in Class B are still healthy, with a life expectancy of 6 to 10 years. As a result, these people have plenty of time to seek sophisticated therapy alternatives such as a liver transplant.
Chronic rejection usually leads to the loss of bile ducts (ductopenia). Another liver transplant may be needed. Rejection is suspected when the liver starts to work less well.
The cumulative incidence of wait-list mortality in frail vs nonfrail candidates at 6 months was 8.0% (23 of 290) vs 4.0% (33 of 818), at 1 year was 16.5% (48 of 290) vs 8.4% (68 of 818), and at 3 years was 32.0% (93 of 290) vs 17.0% (139 of 818).