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Should length of sobriety be a major determinant in liver transplant selection?

Rice, John P.; Lucey, Michael R.

Current Opinion in Organ Transplantation: June 2013 - Volume 18 - Issue 3 - p 259–264
doi: 10.1097/MOT.0b013e32835fb94b
LIVER TRANSPLANTATION: Edited by Federico G. Villamil

Purpose of review For patients with alcoholic liver disease, most liver transplant programs enforce a mandatory period of sustained abstinence prior to considering transplant. The ‘6-month’ rule may eliminate potentially acceptable transplant candidates from a lifesaving procedure. This review focuses on the use of sobriety length as a determinant of transplant candidacy and as a predictor of future alcohol use. We will also review the use of liver transplant in patients with severe alcoholic hepatitis, and the impact of alcohol use on posttransplant outcomes.

Recent findings Patients with alcoholic hepatitis that underwent transplantation had an increased survival when compared with controls. Alcohol relapse after transplantation was infrequent. Similarly, a United Network for Organ Sharing database review revealed similar survival in patients transplanted for alcoholic hepatitis versus alcoholic cirrhosis. Allograft loss due to alcohol use was not seen. However, alcohol usage after transplantation has been associated with a lower long-term survival in both alcoholic and nonalcoholic recipients.

Summary The 6-month rule is insufficient in predicting relapse risk. Liver transplantation may be lifesaving in cases of alcoholic hepatitis and inflexible sobriety rules may eliminate patients from transplant consideration at a low risk of relapse. An ongoing alcohol use assessment, both pre- and posttransplant, are critical to achieving good long-term outcomes.

Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA

Correspondence to Michael R. Lucey, MD, Professor of Medicine, Chief, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Suite 4000, Madison, WI 53705-2281, USA. Tel: +1 608 263 7322; fax: +1 608 265 5677; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins