Alcohol use disorder and liver transplant: new perspectives and critical issues

• Main Authors: Stefano Gitto, Silvia Aspite, Lucia Golfieri, Fabio Caputo, Francesco Vizzutti, Silvana Grandi, Valentino Patussi, Fabio Marra
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2020-07-01
• Series: The Korean Journal of Internal Medicine
• Subjects: liver diseases, alcoholic; alcoholism; alcohol and transplant
• Online Access: http://www.kjim.org/upload/pdf/kjim-2019-409.pdf
• ISSN: 1226-3303; 2005-6648

Alcoholic liver disease is a consolidated indication for liver transplantation, but many unsolved issues can be highlighted. Patients with alcohol use disorder develop peculiar comorbidities that can become contraindications for transplantation. Moreover, a number of social and psychological patterns should be evaluated to select candidates with a low risk of alcohol relapse and adequate post-transplant adherence. In this context, the 6-month rule is too rigid to be widely applied. A short period of abstinence (1 to 3 months) is useful to estimate recovery of liver function and, possibly to avoid transplant. Cardiovascular disorders and extra-hepatic malignancies represent the main clinical issues after transplant. Patients transplanted due to alcoholic disease are a major risk for other liver diseases. Severe corticosteroid-resistant alcoholic acute hepatitis is a debated indication for transplant. However, available data indicate that well-selected patients have excellent post-transplant outcomes. Behavioral therapy, continued psychological support and a multidisciplinary team are essential to achieve and maintain complete alcohol abstinence during the transplant process. Alcoholic liver disease is an excellent indication for a liver transplant but patients with alcohol use disorder deserve a personalized approach and dedicated resources.