2012, Number 2
<< Back Next >>
Ann Hepatol 2012; 11 (2)
Predictive factors of abstinence in patients undergoing liver transplantation for alcoholic liver disease
Altamirano J, Bataller R, Cardenas A, Michelena J, Freixa N, Monrás M, Ríos J, Liccioni A, Caballería J, Gual A, Lligoña A
Language: English
References: 34
Page: 213-221
PDF size: 105.39 Kb.
ABSTRACT
Introduction. Alcoholic cirrhosis is one of the most common indications for liver transplantation (LT) in
western countries. A major concern about transplant patients due to alcoholic liver disease (ALD) is alcoholic
recidivism. Data concerning psycho-social characteristics of patients with 6 months of abstinence at
initial evaluation for LT is scarce.
Objectives. The aims of this study were 1) To evaluate the psycho-social
profile of a cohort of patients with alcoholic cirrhosis being evaluated for LT. 2) Determine factors associated
with abstinence from alcohol at initial psycho-social evaluation for LT and 3) To evaluate the potential
impact of alcohol-free beer consumption on 6-month abstinence.
Material and methods. Ninety
patients referred to the Alcohol Unit of the Hospital Clínic of Barcelona (January 1995-December 1996)
were included. Univariate and multivariate logistic regression analyses were used to identify the factors
associated with cessation in alcohol consumption and with 6-month abstinence.
Results. Factors associated
with cessation in alcohol consumption were awareness of alcohol toxicity (OR = 5.84, CI 1.31-26.11,
p = 0.02) and family recognition (OR = 3.81, CI 1.27-11.41, p = 0.01). Cessation of alcohol consumption at
knowledge of ALD (OR = 5.50, CI 1.52-19.81, p = 0.009), awareness of alcohol toxicity (OR = 2.99, CI 1.02-
9.22, p = 0.05) and family recognition (OR = 5.21, CI 1.12-24.15, p = 0.03) were the independent factors associated
with 6-month abstinence previous to psycho-social evaluation for LT.
Conclusion. In conclusion
awareness of alcohol toxicity and family recognition are the independent factors that influence cessation
in alcohol consumption and 6-month abstinence in patients evaluated for LT. The use of alcohol-free beer
was associated with a higher rate of abstinence in patients without alcohol cessation.
REFERENCES
Centers for Disease Control and Prevention (CDC). Alcohol- attributable deaths and years of potential life lost among American Indians and Alaska Natives—United States, 2001—2005. MMWR Morb Mortal Wkly Rep 2008; 57: 938-41.
Cortez-Pinto H, Gouveia M, dos Santos Pinheiro L, et al. The burden of disease and the cost of illness attributable to alcohol drinking—results of a national study. Alcohol Clin Exp Res 2010; 34: 1442-9.
Balakrishnan R, Allender S, Scarborough P, et al. The burden of alcohol-related ill health in the United Kingdom. J Public Health (Oxf) 2009; 31: 366-73.
Méndez-Sánchez N, García-Villegas E, Merino-Zeferino B, et al. Liver diseases in Mexico and their associated mortality trends from 2000 to 2007: A retrospective study of the nation and the federal states. Ann Hepatol 2010; 9: 428-38.
Pessione F, Ramond MJ, Peters L, et al. Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence. Liver Int 2003; 23: 45-53.
Carrion AF, Ghanta R, Carrasquillo O, et al. Chronic Liver Disease in the Hispanic Population of the United States. Clin Gastroenterol Hepatol 2011. Doi: 10.1016/ j.cgh.2011.04.027.
Burra P, Senzolo M, Adam R, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant 2010; 10: 138-48.
Waki K, Tamura S, Sugawara Y, et al. An analysis of the OPTN/UNOS Liver Transplant Registry. Clin Transpl 2009: 55-64.
Kotlyar DS, Burke A, Campbell MS, et al. A critical review of candidacy for orthotopic liver transplantation in alcoholic liver disease. Am J Gastroenterol 2008; 103(3): 734-43; Quiz 744. Epub 2007 Dec 14.
Burra P, Mioni D, Cillo U, et al. Long-term medical and psycho-social evaluation of patients undergoing orthotopic liver transplantation for alcoholic liver disease. Transpl Int 2000; 13(Suppl. 1): S174-S178.
Lucey MR. Liver transplantation in patients with alcoholic liver disease. Liver Transpl 2011; 17: 751-9.
Gish RG, Lee AH, Keeffe EB, Rome H, Concepcion W, Esquivel CO. Liver transplantation for patients with alcoholism and end-stage liver disease. Am J Gastroenterol 1993; 88: 1337-42.
Lim JK, Keeffe EB. Liver transplantation for alcoholic liver disease: current concepts and length of sobriety. Liver Transpl 2004; 10(Suppl. 2): S31-S38.
Tandon P, Goodman K, Ma MM, et al. The duration of pretransplant abstinence predicts problem drinking post liver transplantation. Am J Gastroenterol 2009; 104: 1700-6.
Osorio RW, Ascher NL, Avery M, et al. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hepatology 1994; 20: 105-10.
Kumar S, Stauber RE, Gavaler JS, et al. Orthotopic liver transplantation for alcoholic liver disease. Hepatology 1990; 11: 159-64.
Gish RG, Lee A, Brooks L, et al. Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation. Liver Transp 2001; 7: 581-7.
Foster PF, Fabrega F, Karademir S, et al. Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation. Hepatology 1997; 25: 1469-77.
Jauhar S, Talwalkar JA, Schneekloth T, et al. Analysis of factors that predict alcohol relapse following liver transplantation. Liver Transpl 2004; 10: 408-11.
Mackie J, Groves K, Hoyle A, et al. Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism. Liver Transpl 2001; 7: 418-27.
Coffman KL, Hoffman A, Sher L, et al. Treatment of the postoperative alcoholic liver transplant recipient with other addictions. Liver Transpl Surg 1997; 3: 322-7.
Harper RG, Wager J, Chacko RC. Psychosocial factors in noncompliance during liver transplant selection. J Clin Psychol Med Settings 2010; 17: 71-6.
Cuadrado A, Fabrega E, Casafont F, et al. Alcohol recidivism impairs long-termpatient survival after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl 2005; 11: 420–6.
Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, American Psychiatric Association, Washington, D.C. 1994. Spanish version: DSM-IV-TR. Manual Diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson; 2003.
Gual A, Contel M, Segura L, et al. The ISCA (Systematic Interview of Alcohol Consumption), a new instrument to detect risky drinking. Med Clin 2001; 117: 685-9.
Graham JR, Strenger VE. MMPI characteristics of alcoholics: a review. J Consult Clin Psychol 1988; 56: 197-205.
Lligoña A, Freixa N, Bataller R. Clinical guideline for the evaluation of liver transplant candidates with addictions. Gastroenterol Hepatol 2009; 32: 155-61.
Lucey MR, Schaubel DE, Guidinger MK, et al. Effect of alcoholic liver disease and hepatitis C infection on waiting list and posttransplant mortality and transplant survival benefit. Hepatology 2009; 50: 400-6.
Carbonneau M, Jensen LA, Bain VG, et al. Alcohol use while on the liver transplant waiting list: a single-center experience. Liver Transp 2010; 16(1): 91-7.
Pfitzmann R, Schwenzer J, Rayes N, et al. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl 2007; 13: 197-205.
Karman JF, Sileri P, Kamuda D. Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis. Transplantation 2001; 15(71): 1210-3.
Monras M, Freixa N, Lligoña A, Gual A. Defensividad psicológica y deterioro cognitivo en alcohólicos. ¿Están relacionados y son útiles para el pronóstico a los 5 años? Psiq Biol 1999; 6(4): 154-68.
Kelly M, Chick J, Gribble R, et al. Predictors of relapse to harmful alcohol after orthotopic liver transplantation. Alcohol Alcohol 2006; 41: 278-83.
Prochaska JO, Di Clemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice 1982; 276-88.