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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk of alcohol use relapse after liver transplantation for alcoholic liver disease
Yasuharu Onishi, Hiroyuki Kimura, Tomohide Hori, Shinichi Kishi, Hideya Kamei, Nobuhiko Kurata, Chisato Tsuboi, Naoko Yamaguchi, Mayu Takahashi, Saki Sunada, Mitsuaki Hirano, Hiroshige Fujishiro, Takashi Okada, Masatoshi Ishigami, Hidemi Goto, Norio Ozaki, Yasuhiro Ogura
Yasuharu Onishi, Tomohide Hori, Hideya Kamei, Nobuhiko Kurata, Yasuhiro Ogura, Department of Transplantation Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan
Hiroyuki Kimura, Shinichi Kishi, Mayu Takahashi, Saki Sunada, Mitsuaki Hirano, Hiroshige Fujishiro, Takashi Okada, Norio Ozaki, Department of Psychiatry, Nagoya University Hospital, Nagoya, Aichi 466-8550, Japan
Chisato Tsuboi, Naoko Yamaguchi, Transplant Coordination Service, Nagoya University Hospital, Nagoya, Aichi 466-8550, Japan
Masatoshi Ishigami, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
Author contributions: Onishi Y and Kimura H contributed equally to this work; Onishi Y wrote the initial draft; Onishi Y, Kimura H and Hori T revised the manuscript; Onishi Y, Kimura H, Kamei H, Kurata N, Tsuboi C, Yamaguchi N, Takahashi M, Sunada S, Hirano M, Fujishiro H, Okada T, Ishigami M, Goto H and Ogura Y helped to collect clinical data and to review the literature; Kishi S helped to perform statistical analyses; Ozaki N provided academic opinions on peri-operative psychiatric management and supervised this research; Ogura Y helped supervised the study and critically revised the manuscript.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Nagoya University Graduate School of Medicine (Approval No. 15).
Informed consent statement: Which waived the requirement for informed consent due to the retrospective design of this study.
Conflict-of-interest statement: None of the authors has any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yasuharu Onishi, MD, PhD, Department of Transplantation Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
onishiy@med.nagoya-u.ac.jp
Telephone: +81-52-7442248 Fax: +81-52-7441911
Received: September 16, 2016
Peer-review started: September 18, 2016
First decision: October 20, 2016
Revised: November 6, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 7, 2017
Processing time: 127 Days and 16.4 Hours
AIM
To investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).
METHODS
The clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial criteria.
RESULTS
Of the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period (P < 0.01), duration of heavy drinking (P < 0.05), adherence to medical treatment (P < 0.01), and declaration of abstinence (P < 0.05).
CONCLUSION
Patients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.
Core tip: Although alcoholic liver disease (ALD) is the second most common indication for liver transplantation (LT), post-transplant relapse of alcohol use can have a negative impact on patient outcomes. It is therefore important to preoperatively assess the risk of post-transplant alcohol use. To date, however, psychosocial evaluation criteria of LT for ALD have not been established, indicating a real need for useful criteria to assess the risks of post-transplant alcohol use. This study describes a set of psychosocial evaluation criteria that may be useful in assessing the risk of relapse in patients who undergo LT for ALD.
