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Choudhary NS, Podisatti A, Dhampalwar S, Singh KA, Saraf N, Soin AS. Prevalence of Modifiable Risk Factors for de novo Malignancies After Living Donor Liver Transplantation. J Clin Exp Hepatol 2024; 14:101362. [PMID: 38495075 PMCID: PMC10937305 DOI: 10.1016/j.jceh.2024.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
| | - Ajay Podisatti
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
| | - Swapnil Dhampalwar
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
| | - Kunwar A. Singh
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, Haryana, India
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Kim SH, Jang Y, Kim H. Concept and risk factors of alcohol relapse in liver transplant recipients with alcohol-related aetiologies: A scoping review. Int J Ment Health Nurs 2023; 32:1583-1597. [PMID: 37475208 DOI: 10.1111/inm.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
Alcohol relapse in those who received liver transplantation (LT) for alcohol-related liver disease can lead to poor graft function, low medication adherence rates and decreased chances of survival. Numerous studies have evaluated on this topic; however, discrepancies in the meaning and measurement of 'alcohol relapse' lead to heterogeneous results. This scoping review aimed to explore the conceptual and operational definitions of alcohol relapse in LT recipients with alcohol-related aetiologies and to examine newly reported risk factors of alcohol relapse. Following the Arksey and O'Malley scoping review method and PRISMA guidelines, structured searches for articles published from 2012 to 2022 were conducted in PubMed, CINAHL, Embase, Cochrane and PsycINFO. Twenty-eight studies were included in the final review. Alcohol relapse was either defined as 'any alcohol consumption' or 'a certain degree of alcohol drinking' after transplantation. Discrepancies in the incidence rates persisted even within studies that shared the same conceptual definition. Commonly reported risk factors for alcohol relapse were younger age, social isolation and shorter abstinence periods before LT. Self-efficacy and post-transplant complications were newly identified risk factors in recent studies; whereas environmental factors such as external stressors were rarely included. The variance in the definition of alcohol relapse and inconsistent identification methods make it difficult to organize a structured interventional study. A standardized stratification of post-LT alcohol relapse behaviour is needed to prior to implementing interventions that employ a harm minimization approach. Cost-effective interventions promoting self-efficacy could enable the prevention and management of alcohol relapse after LT.
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Affiliation(s)
| | - Yeonsoo Jang
- College of Nursing·Mo-im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Hyunji Kim
- College of Nursing, Yonsei University, Seoul, Korea
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Chálim Rebelo C, Félix C, Cardoso FS, Bagulho L, Sousa M, Mendes M, Glória H, Mateus É, Mega I, Jara M, Pinto Marques H, Nolasco F, Martins A, Perdigoto R. Alcohol Consumption Post-Liver Transplantation: A Cross-Sectional Study. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:343-349. [PMID: 37868639 PMCID: PMC10586211 DOI: 10.1159/000525808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/16/2022] [Indexed: 10/24/2023]
Abstract
Background Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center. Methods We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients' self-reports or a positive AUDIT. Results In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20-26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2-4 times/month. On drinking days, 18 patients usually consumed 1-2 drinks and the remainder no more than 3-4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score <8) as per the AUDIT score (median [IQR] of 1 [1-2]). No patient reported alcohol-related problems, whether self-inflicted or toward others. Drinking recipients were younger (53 vs. 59 years, p = 0.020), had more non-ALD-related LT (72.7 vs. 44.2%, p = 0.018) and active smoking (31.8 vs. 10.4%, p = 0.037) than abstinent ones. Conclusion In our cohort, about a quarter of LT recipients consumed alcohol early posttransplant, all with a low-risk pattern according to the AUDIT score.
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Affiliation(s)
| | - Catarina Félix
- Gastroenterology Division, Western Lisbon Hospital Center, Lisbon, Portugal
| | - Filipe S. Cardoso
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Luis Bagulho
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Monica Sousa
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Milena Mendes
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Helena Glória
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Élia Mateus
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Inês Mega
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Miguel Jara
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Hugo Pinto Marques
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Fernando Nolasco
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Américo Martins
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
| | - Rui Perdigoto
- Transplant Unit, Curry Cabral Hospital, Central Lisbon University Hospital Center, Nova Medical School, Nova University, Lisbon, Portugal
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Murthy P, Shadakshari D, Mahadevan J, Chand PK. Management of Alcohol Use Disorder in Patients With Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1514-1526. [PMID: 36340303 PMCID: PMC9630026 DOI: 10.1016/j.jceh.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/10/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a common condition that develops on the background of heavy alcohol use and is characterised by the loss of control over alcohol use and a compulsion to use alcohol, often despite negative consequences. AUD is a leading cause for the resumption of alcohol use in patients with alcoholic liver disease (ALD) after treatment. Hence it is essential to screen all patients with ALD for the presence of AUD. Screening tools such as alcohol use disorders identification test (AUDIT) and AUDIT-C are used, following which the diagnosis and severity of AUD are determined using DSM-5 criteria. The management of AUD in patients with ALD is best carried out using an integrated approach involving psychiatrists and gastroenterologists/hepatologists. The treatment most often involves a combination of pharmacotherapy and psychosocial interventions which try to achieve and maintain abstinence. Although, there is limited evidence, Baclofen is the first line pharmacological agent for long-term management of AUD in patients with ALD. Intensive psychological interventions such as motivation enhancement therapy and cognitive behavioural therapy are also seen to be beneficial. Treatment retention and follow-up are vital and can positively influence outcomes.
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Key Words
- AA, Alcoholics Anonymous
- ALD, Alcoholic Liver Disease
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- AUD, Alcohol Use Disorder
- AUDIT – C, Alcohol Use Disorder Identification Test – Consumption
- AUDIT, Alcohol Use Disorder Identification Test
- CBT, Cognitive Behavioural Therapy
- CDT, Carbohydrate Deficient Transferrin
- CIWA – Ar, Clinical Institute Withdrawal Assessment for Alcohol Revised
- DALY, Disability Adjusted Life Years
- EtG, Ethyl glucuronide
- EtS, Ethyl Sulphate
- FAEE, Fatty acid ethyl ester
- FDA, Food and Drug Administration
- GABA, Gamma-Aminobutyric acid
- GGT, Gamma glutamyl transferase
- HCV, Hepatitis C Virus
- HE, Hepatic Encephalopathy
- LT, Liver Transplantation
- MCV, Mean corpuscular volume
- MET, Motivation Enhancement Therapy
- MI, Motivational Interviewing
- NMDA, N-Methyl-d-aspartate
- PEth, Phosphatidylethanol
- RCT, Randomised control trial
- SMS, Short Message Service
- alcohol use disorder
- alcoholic liver disease
- diagnosis
- pharmacotherapy
- psychotherapy
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Affiliation(s)
- Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Darshan Shadakshari
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Chang WJ, Hsieh CE, Hung YJ, Hsu YL, Lin KH, Chen YL. Length of Alcohol Abstinence Predicts Posttransplant Delirium in Living Donor Liver Transplant Recipients with Alcoholic Cirrhosis. EXP CLIN TRANSPLANT 2022; 20:750-756. [DOI: 10.6002/ect.2022.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shafqat M, Jo JH, Moon HH, Choi YI, Shin DH. Alcohol-related liver disease and liver transplantation. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Alcohol-related liver disease (ALD) has become the major cause of liver transplantation (LT) in Korea, and is currently the most common cause of LT in Europe and the United States. Although, ALD is one of the most common indications for LT, it is traditionally not considered as an option for patients with ALD due to organ shortages and concerns about relapse. To select patients with terminal liver disease due to ALD for transplants, most LT centers in the United States and European countries require a 6-month sober period before transplantation. However, Korea has a different social and cultural background than Western countries, and most organ transplants are made from living donors, who account for approximately twice as many procedures as deceased donors. Most LT centers in Korea do not require a specific period of sobriety before transplantation in patients with ALD. As per the literature, 8%–20% of patients resume alcohol consumption 1 year after LT, and this proportion increases to 30%–40% at 5 years post-LT, among which 10%–15% of patients resume heavy drinking. According to previous studies, the risk factors for alcohol relapse after LT are as follows: young age, poor familial and social support, family history of alcohol use disorder, previous history of alcohol-related treatment, shorter abstinence before LT, smoking, psychiatric disorders, irregular follow-up, and unemployment. Recognition of the risk factors, early detection of alcohol consumption after LT, and regular follow-up by a multidisciplinary team are important for improving the short- and long-term outcomes of LT patients with ALD.
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Abstract
Content available: Audio Recording.
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Affiliation(s)
- Narendra S. Choudhary
- Medanta Institute of Liver Transplantation and Regenerative MedicineMedanta The MedicityGurugramIndia
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative MedicineMedanta The MedicityGurugramIndia
| | - Arvinder S. Soin
- Medanta Institute of Liver Transplantation and Regenerative MedicineMedanta The MedicityGurugramIndia
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Choudhary NS, Saraf N, Dhampalwar S, Saigal S, Gautam D, Rastogi A, Bhangui P, Srinivasan T, Rastogi V, Mehrotra S, Soin AS. Poor Outcomes after Recidivism in Living Donor Liver Transplantation for Alcohol-Related Liver Disease. J Clin Exp Hepatol 2022; 12:37-42. [PMID: 35068783 PMCID: PMC8766539 DOI: 10.1016/j.jceh.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Recidivism in patients who underwent liver transplantation for alcohol-related liver disease (ALD) is shown to be associated with poor survival in some studies. METHODS Living donor liver transplantation (LDLT) recipients for ALD with at least 2 years of follow-up and history of significant alcohol relapse were included. The recipients underwent LDLT from June 2010 to December 2016, and data were analyzed until June 2019. The cohort had a median follow-up of 54 (33-78 IQR) months. Recidivism (significant alcohol intake) was defined as >21 units per week. RESULTS A total of 27 of 463 (5.8%) LDLT recipients (all men), aged 43.5 ± 9.6 years, had significant alcohol intake. A liver biopsy was performed on demand in 14 patients (in the presence of raised levels of liver enzymes or jaundice). The histological diagnoses in these patients were as follows: alcoholic hepatitis in 7 (50%), alcoholic hepatitis and acute cellular rejection or chronic rejection in 4 (28.5%), cirrhosis in 2 (14.2%), and acute cellular rejection and cirrhosis in 1 (7.1%) patient. Four of 5 patients with a biopsy diagnosis of acute or chronic rejection were noncompliant with immunosuppression. Six of these patients died. The mortality after 1 year of transplant was significantly more in patients with recidivism. CONCLUSION Recidivism was associated with significant morbidity and mortality after liver transplantation.
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Affiliation(s)
- Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India,Address for correspondence: Dr Neeraj Saraf, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Medanta The Medicity Hospital, Sector 38, Gurugram, Delhi (NCR), India. Tel.: +919899077795.
| | - Swapnil Dhampalwar
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Dheeraj Gautam
- Department of Pathology, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Amit Rastogi
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Thiagrajan Srinivasan
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Vipul Rastogi
- Department of Mental Health, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Saurabh Mehrotra
- Department of Mental Health, Medanta the Medicity, Gurugram, Delhi (NCR), India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurugram, Delhi (NCR), India
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Raju S, Mathew JS, S S, Padma UD. Quality of life 5 years following liver transplantation. Indian J Gastroenterol 2021; 40:353-360. [PMID: 34244962 DOI: 10.1007/s12664-021-01180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on quality of life (QOL) among liver transplant recipients from India is scarce. We conducted a prospective assessment of QOL and incidence of complications 5 years following liver transplantation (LT). METHODS Demographic data of 130 patients (M:F = 98:32, mean age 38.4 ± 14.9 years) who had completed at least 5 years after LT were collected and the incidence of new onset metabolic complications and renal dysfunction was analyzed. Liver transplant database (LTD QOL) questionnaire was given to 100 patients and scoring was done on five QOL domains. This was compared to a historical cohort from the liver transplant database of three transplant centres from North America, who had completed the same questionnaire before and 1 year after LT. RESULTS The incidence of new onset dyslipidemia, diabetes mellitus, renal dysfunction, hypertension and overweight/obesity was 43%, 26.7%, 25%, 16.4% and 15.4%, respectively. Although ethanol-related cirrhosis was the etiology for transplant in 38%, recidivism was not evident in any recipient in this cohort even after 5 years. Significant improvement in QOL was observed in all five domains, namely measures of disease (p=0.001), psychological status (p=0.001), personal function (p=0.001), social and role function (p=0.001) and general health perception (p=0.001) in our patients 5 years after transplant compared to historical data. CONCLUSION Although metabolic disease is common after LT, there is significant improvement in long-term QOL. Recidivism appeared to be rare in our study population.
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Affiliation(s)
- Surya Raju
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India
| | - Johns Shaji Mathew
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India
| | - Sudhindran S
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India
| | - Uma Devi Padma
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India.
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Choudhary NS, Saraf N, Mehrotra S, Saigal S, Soin AS. Recidivism in Liver Transplant Recipients for Alcohol-related Liver Disease. J Clin Exp Hepatol 2021; 11:387-396. [PMID: 33994719 PMCID: PMC8103326 DOI: 10.1016/j.jceh.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation (LT) is the only cure for patients with end-stage liver disease, which offers good long-term survival. The long-term issues after LT affecting survival are cardiovascular disease, chronic kidney disease, de novo malignancies, recurrence of original disease and immunological causes. Alcoholic-related liver disease (ALD) is one of the most common indications for LT worldwide including India. LT for ALD is associated with several unique challenges as compared with other etiologies. Long-term survival after LT in patients with ALD is affected by recidivism. Various studies have shown different predictors of relapse; the main predictors of relapse are pretransplant abstinence, psychiatric comorbidities, and lack of social support. Although several risk scores have been proposed, these scores are not validated. Studies with active involvement of psychiatrist have shown lower relapse rates. The relapse prevention strategy for reducing likelihood and severity of relapse after initial cessation of alcohol uses a combination of pharmacotherapy and cognitive behavioral approach (identifying and addressing high-risk situations for relapse).
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Affiliation(s)
- Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India,Address for correspondence: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity hospital, sector 38, Gurgaon, Delhi (NCR), India.
| | - Saurabh Mehrotra
- Department of Mental Health, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
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Choudhary NS, Saigal S, Gautam D, Saraf N, Rastogi A, Goja S, Bhangui P, Thiagrajan S, Yadav SK, Mehrotra S, Rastogi V, Soin AS. Good outcome of living donor liver transplantation for severe alcoholic hepatitis not responding to medical management: A single center experience of 39 patients. Alcohol 2019; 77:27-30. [PMID: 30772702 DOI: 10.1016/j.alcohol.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION There are limited data on outcomes of living donor liver transplantation (LDLT) for patients with severe alcoholic hepatitis. METHODS The study included LDLT recipients for severe alcoholic hepatitis (n = 39) who did not improve with medical treatment and compared their outcomes with patients who underwent LDLT for alcoholic liver disease (n = 461). The diagnosis of severe alcoholic hepatitis was based on both clinical and explants data. No patients had psychiatric contraindications for liver transplant and all had good family support. The data are shown as number, mean (SD), or median (25-75 interquartile range). RESULTS All transplant recipients were males, aged 42 ± 8 years. The patients with alcoholic hepatitis were abstinent for a duration of 4 ± 1.8 months at the time of LDLT. All patients underwent LDLT with a graft to recipient weight ratio of 0.95 ± 0.17. The post-transplant ICU and hospital stay were 5.4 ± 1.3 and 17.6 ± 8.4 days, respectively. When patients with alcoholic hepatitis (n = 39) were compared to patients who underwent LDLT for alcoholic liver disease without alcoholic hepatitis (n = 461), patients with alcoholic hepatitis were significantly younger (43.2 ± 8.5 vs. 48.2 ± 9.1 years, p = 0.001) and had higher Child's (10.9 ± 1.5 vs. 9.8 ± 1.8) and MELD scores (22.1 ± 4.5 vs. 18.4 ± 5.9, p = 0.000). Post-operative infections were also significantly more common in the alcoholic hepatitis group (71.7% vs. 51.6%, p = 0.018). Fungal infections developed in 23% of alcoholic hepatitis patients as compared to 14% in the rest of the alcoholic patients (p = 0.247). Six recipients (15.7%) died at a median follow-up of 28 (6-37) months due to infections, and five (12.8%) patients had relapse of alcohol drinking. Survival was not different between the two groups. CONCLUSION Living donor liver transplantation can be successfully performed with good survival for patients with severe alcoholic hepatitis.
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Affiliation(s)
- Narendra S Choudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjiv Saigal
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India.
| | - Dheeraj Gautam
- Department of Histopathology, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Neeraj Saraf
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Amit Rastogi
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjay Goja
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Srinivasan Thiagrajan
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjay K Yadav
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Saurabh Mehrotra
- Department of Mental Health and Quality of Life, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Vipul Rastogi
- Department of Mental Health and Quality of Life, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Arvinder S Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
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Ursic-Bedoya J, Donnadieu-Rigole H, Faure S, Pageaux GP. Alcohol use and smoking after liver transplantation; complications and prevention. Best Pract Res Clin Gastroenterol 2017. [PMID: 28624106 DOI: 10.1016/j.bpg.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The last thirty years have been very prosperous in the field of liver transplantation (LT), with great advances in organ conservation, surgical techniques, peri-operative management and long-term immunosuppression, resulting in improved patient and graft survival rates as well as quality of life. However, substance addiction after LT, namely alcohol and tobacco, results in short term morbidity together with medium and long-term mortality. The main consequences can be vascular (increased risk of hepatic artery thrombosis in smokers), hepatic (recurrent alcoholic cirrhosis in alcohol relapsers) and oncological (increased risk of malignancy in patients consuming tobacco and/or alcohol after LT). This issue has thus drawn attention in the field of LT research. The management of these two at-risk behaviors addictions need the implication of hepatologists and addiction specialists, before and after LT. This review will summarize our current knowledge in alcohol use and cigarette smoking in the setting of LT, give practical tools for identification of high risk patients and treatment options.
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Affiliation(s)
- José Ursic-Bedoya
- Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, 34295, Montpellier Cedex 5, France
| | - Hélène Donnadieu-Rigole
- Addictology Department, Saint Eloi University Hospital, University of Montpellier, 34295, Montpellier Cedex 5, France
| | - Stéphanie Faure
- Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, 34295, Montpellier Cedex 5, France
| | - Georges-Philippe Pageaux
- Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, 34295, Montpellier Cedex 5, France.
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