Living donor liver transplantation for alcoholic liver disease

Abstract

Aims: Alcoholic liver disease (ALD) is now a well-recognized indication for liver transplantation. This paper reviews existing literature on living donor liver transplantation (LDLT) for ALD and presents data from a single, high volume United States liver transplant center. Methods: For the literature review, a PubMed search was undertaken using the search terms 'living donor' and 'alcoholic liver disease'. Studies were included that presented outcome data for patients who underwent LDLT for ALD. For the single-center data collection, all patients who underwent LDLT from 2003 to 2016 at our center were reviewed and the data for recipients with ALD was subsequently analyzed and compared with those patients who underwent LDLT for other indications. Results: Of 110 studies that resulted from the PubMed query, only 5 contained data that was relevant to this manuscript. These studies represented data collected from two Asian countries: one single center in Korea and a collection of centers in Japan. The relapse rate following LDLT for ALD ranged from 7.9% to 22%, and pre-transplant abstinence did not impact post-transplant relapse in any of these studies. For the single-center data, of 136 LDLT performed at our institution during the time period, 22 were performed for ALD. There was no difference in 1-or 5-year survival between patients transplanted for ALD and those transplanted for other etiologies (94.7% vs. 93.4%, P = 0.79 and 78.9% vs. 87.5%, P = 0.6). Conclusion: There is a very limited amount of data available on LDLT for ALD. Existing data suggests that LDLT for ALD results in excellent outcomes. Short Summary: Published data on living donor liver transplantation (LDLT) for alcoholic liver disease (ALD) are limited. One- and five-year survival rates range from 82% to 100% and 78% to 87%, respectively. Rates of alcohol relapse following transplant appear low, ranging from 7% to 23%; 6-month abstinence periods prior to LDLT for ALD do not appear to have a significant impact on relapse.