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Long Term Follow-up and Outcome of Liver Transplantation for Alcoholic Liver Disease: A Single Center Case-control Study

Biselli, Maurizio MD, PhD*; Gramenzi, Annagiulia MD*; Gaudio, Massimo Del MD, PhD; Ravaioli, Matteo MD, PhD; Vitale, Giovanni MD*; Gitto, Stefano MD*; Grazi, Gian Luca MD, PhD; Pinna, Antonio Daniele MD, PhD; Andreone, Pietro MD*; Bernardi, Mauro MD*; and Bologna Liver Transplantation Group

Journal of Clinical Gastroenterology: January 2010 - Volume 44 - Issue 1 - pp 52-57
doi: 10.1097/MCG.0b013e3181a390a8
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Background: Alcoholic liver cirrhosis (ALC) is a leading indication for orthotopic liver transplantation (OLT).

Goals: To investigate the long-term outcome of OLT for ALC compared with patients transplanted for hepatitis C virus (HCV) infection.

Study: From 1987 to 2001, 49 OLT were performed for ALC and 173 for HCV. From these contemporary groups we matched 1:2 ALC patients (cases) to 98 HCV (controls). The following variables were analyzed: survival, retransplantation, rejection, primary nonfunction, infections, de novo tumors, cardiovascular and neurologic complications, and alcoholic recurrence.

Results: Actuarial survival rate at 9 years was comparable for cases and controls. Actuarial graft survival rate at 9 years was significantly higher in cases (78% vs. 60%; P=0.026). The retransplantation rate was higher in controls (21% vs. 4%; P=0.007). Post-OLT complications were not significantly different. The alcoholic recidivism rate was 28% without influence on patients or graft survival, whereas relapse of HCV caused the majority of death in controls (30%; P=0.042). At multivariate analysis retransplantation was the only predictor of patient survival (odds ratio: 4.35; 95% confidence interval: 2.16-8.74; P<0.001), whereas HCV was associated with a 2-fold probability of graft failure (odds ratio: 1.97; 95% confidence interval: 1.02-3.81; P=0.032).

Conclusions: The long-term outcome of OLT for ALC is comparable to that for HCV, even if graft survival is significantly better among ALC. These data support ALC as an excellent indication for OLT.

*Department of Clinical Medicine

Department of General Surgery and Organ Transplantation, University of Bologna, Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy

Reprints: Pietro Andreone, MD, Dipartimento di Medicina Clinica, Alma Mater Studiorum, Università di Bologna, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy (e-mail: pietro.andreone@unibo.it).

Received for publication January 12, 2009; accepted March 1, 2009

Members of Bologna Liver Transplantation Group: Sonia Bernardi, MD; Francesco Bianco Bianchi, MD; Luigi Bolondi, MD; Matteo Cescon, MD; Antonio Colecchia, MD; Antonia D'Errico, MD; Giorgio Ercolani, MD; Walter Grigioni, MD; Marco Lenzi, MD; Francesca Lodato, MD; Stefania Lorenzini, MD, PhD; Giuseppe Mazzella, MD; Maria Cristina Morelli, MD; Fabio Piscaglia, MD; Enrico Roda, MD; Claudia Sama, MD; Maria Rosa Tamè, MD; Marco Vivarelli, MD.

Authors' declaration of personal conflict of interests: Nothing to declare.

Declaration of Funding Sources: Nothing to declare.

© 2010 Lippincott Williams & Wilkins, Inc.