Liver transplantation for alcoholic liver disease

Table 1 Michigan alcoholism prognosis scale

Criterion	Points
Acceptance of alcoholism
Patient and family	4
Patient only	3
Family only	2
Neither	1
Prognostic indices
Substitute activities	Yes 3, No 1
Behavioral consequences	Yes 3, No 1
Hope/self-esteem	Yes 3, No 1
Social relationship	Yes 3, No 1
Social stability
Steady job	1
Stable residence	1
Does not live alone	1
Stable marriage	1
Rating	/201

¹Maximum score.

Table 2 High-risk alcoholism relapse scale

Item	Score
Duration of heavy drinking (yr)
≤ 11	0
11-25	1
≥ 25	2
Daily drinks1 (n)
≤ 9	0
9-17	1
≥ 17	2
Prior alcoholism inpatient treatments (n)
0	0
1	1
≥ 1	2

¹One drink = 12 g of ethanol.

Table 3 Comorbidities associated with alcohol related liver disease

Cardiovascular	Alcoholic cardiomyopathy
	Cirrhotic cardiomyopathy
	Coronary artery disease
Musculoskeletal	Myopathy
	Osteopenia
Neurologic	Wernicke-Korsakoff psychosis
	Alcoholic dementia
	Alcoholic cerebellar degeneration
	Peripheral neuropathy
Malnutrition
Chronic pancreatitis
Hepatocellular carcinoma
Hepatitis B or C infection
Other malignancy	Upper aerodigestive tract malignancy
Psychiatric	Depression or mood disorders
	Personality disorders
	Anxiety disorders
	Psychosis

Table 4 Outcome of post-orthotopic liver transplantation in patients with alcoholic liver disease, combined alcoholic liver disease with hepatitis C virus and hepatitis C virus alone n (%)

Study	ALD	ALD + HCV	HCV	Others
Burra et al[76]	n = 9880	n = 1119	n = 6672
Patient survival 1-yr, 3-yr, 5-yr, 10-yr	84%, 78%, 73%, 58%	84%, 75%, 65%, 52%	81%, 72%, 67%,54%
Aguilera et al[77]	n = 107	n = 60	n = 170
HCC	19 (18)	21 (35)	75 (44)
Graft loss	35 (33)	25 (42)	95 (56)
Severe recurrent HCV disease		22/49 (45)	54/122 (45)
Retransplant	4 (4)	8 (13)	7 (4)
De-novo tumors	14/107 (13)	2/67 (3)	10/67 (6)
Rejection	17/100 (17)	9/60 (15)	32/169 (19)
Patient survival 1-yr, 5-yr, 7-yr	90%, 76%, 67%	86%, 73%, 63%	72%, 49%, 43%
Graft survival 1-yr, 5-yr, 7-yr	89%, 76%, 67%	83%, 63%, 56%	71%, 48%, 43%
Mortality	29 (27)	21 (35)	95 (56)
Cause of death
Recurrent disease	3 (3)	9 (15)	44 (26)
Sepsis	7 (6.5)	7 (12)	26 (15)
De-novo tumors	9 (8)	2 (3.5)	6 (3.5)
Neuberger et al[4]
HCC (%)	11	26	28
Yamauchi et al[78] Yamanaka et al[79]
Risk of HCC (at 10-yr)	15%-20%	50%-80%
Khan et al[80]	n = 14	n = 24	n = 40	n = 42
HCV RNA (Meq/mL)		2.3 ± 1.7	2.7 ± 2.9	2.3 ± 2.6
Necroinflammation	1.8 ± 0.7	3.1 ± 1.1	3.4 ± 1.6	2.9 ± 1.3
Fibrosis	2.9 ± 1.0	3.6 ± 0.7	2.9 ± 0.9	3.4 ± 1.0
Cirrhosis	5 (8.4)	16 (27.2)	10 (16.9)	28 (47.5)
HCC	5 (9)	14 (25.5)	10 (18.2)	26 (47.3)
Size of HCC	1.9 ± 0.8	2.5 ± 0.8	2.5 ± 1.0	2.4 ± 0.9
Donato et al[81]
Relative risk for HCC	4.6	64.7	23.2

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; ALD: Alcoholic liver disease.

Table 5 Post-orthotopic liver transplantation events-rejection, infection, malignancy, retransplantation and cardiac events

Study	Rejection (%)		Infection (%)		Malignancy (%)		Retransplantation (%)		Cardiac events (%)
	ALD	Non-ALD	ALD	Non-ALD	ALD	Non-ALD	ALD	Non-ALD	ALD + viral	Non-ALD
Burra et al[76]	7.6	10.1	15.5	17.6	13.7/5.41	5.6/21			8	5.3
Pfitzmann et al[5]			4.7-6.32		9.4-18.8/3.82				3-11.82
Wiesner et al[83]	Significantly less in ALD vs non-ALD		Bacteremia, overall fungemia, and CMV infection, comparable		De-novo tumors significantly increased in ALD vs non-ALD		3	9
Bhagat et al[84]	23/23	41/43	432	53	292	0	3.6	5.6	72	26

¹De-novo tumors/upper aerodigestive tract tumors;

²Cause of death;

³Acute/chronic rejection. ALD: Alcoholic liver disease.

Table 6 Comparison of outcomes of patients with alcoholic liver disease post-orthotopic liver transplantation

Study	Time period	Number of patients	Survival (%)				Relapse (%) any (abusive)	Death due to relapse (%)
			1-yr	3-yr	5-yr	10-yr
Burra et al[76]	1988-2005	ALD-9880	84	78	73	58	33 (11)	4.3
		ALD + HCV-1119	84	75	65	52		18.3
		ALD + HBV-309	89	85	81	64
		Cryptogenic-2410	78	73	69	61
Bhagat et al[84]	1997-2007	ALD-83	92	86	86	761
		NASH-71	82	79	75	621
Gedaly et al[22]	1995-2007	ALD-147	96.2	89.6	84.4		19
Pfitzmann et al[5]	1989-2002	ALD-300	96		88	76	19 (8)	4.8
		Non-ALD	97		80	72
OPTN/SRTR 2006[113]	1996-2005	All causes of cirrhosis	86.9		82.4
Lim et al[101]	1988-1997	ALD-3063	81.9	73.9	67.9		13
		Viral hepatitis-4267	80.3	71.7	65.3
Bellamy et al[82]		ALD-123	84		72	632	10
Mackie et al[110]	1996-1999	ALD-64	82	823			45.6 (6.5)
		Non-ALD-335	83	823
Gerhardt et al[114]	1985-1991	ALD-67	90	844	824	764	26 (4.8)	4.5
Lucey et al[15]	1985-1989	ALD-45	78	733			4.4
		Non-ALD-111	70	653
Kumar et al[115]	1982-1988	ALD-73	74				11.5	2
		Non-ALD	67

¹9 yr survival;

²7 yr survival;

³2 yr survival;

⁴2-yr, 3-yr and 4-yr survival. HCV: Hepatitis C virus; HBV: Hepatitis B virus; ALD: Alcoholic liver disease.