Transplantation for alcoholic liver disease: Report of a consensus meeting

Abstract

It is clear that liver transplantation has become a recognised and accepted form of treatment for those with end-stage ALD. The evidence base to date suggests that prognosis for survival at 5-years post-transplant is good and that alcohol-related graft damage post-transplant is relatively low. Despite this knowledge, the general public continue to hold reservations about the use of donated livers for those with "self-inflicted" injury such as "alcoholics". Such debate will always be voiced in an era of donor shortage when those with ALD are particularly singled out. There has been less focus of attention toward those with recurrent hepatitis C (HCV) following transplantation, perhaps for intravenous drug use, despite the greater significance of graft loss at 5-years post-transplant. There is also less attention given to obese patients with non-alcoholic fatty liver disease, or teenagers re-grafted following non-compliance. The lack of quality prospective and longitudinal research data on ALD and recidivism post transplant has been highlighted above, and the study group is actively welcoming such research into the arena. However, even less work has been done to tackle the lack of consistent approach both intra- and inter-transplant unit. Such work would be a valid study in itself. Furthermore, little is known about the process of selection of candidates at local liver units for referral on to the transplant assessment teams, which must again question what factors control the selection of assessment candidates. In addition to the question as to "What is relapse?, how much does it occur, and how much does it matter?", the study group would like to see all supra-regional transplant centres demonstrating transparent, measurable assessment processes that sustain an ethical service with equity of access based on factors correctly adjudged to select those candidates likely to do well. Where patients are transplanted outside of inter-unit guidelines, a rationale should be available. Finally, there may be a need for ALD patients to receive ongoing psychological interventions and support post-transplant in order to sustain abstinence and stability post-transplant. Once risk factors have been correctly assessed, then appropriate treatment and support methods can be validated. © 2006 AASLD.