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Outcome After Liver Transplantation for Cirrhosis Due to Alcohol and Hepatitis C: Comparison to Alcoholic Cirrhosis and Hepatitis C Cirrhosis

Singal, Ashwani K. MD*,†; Hmoud, Bashar S. MD*; Guturu, Praveen MD*,†; Kuo, Yong-Fang PhD

Journal of Clinical Gastroenterology: September 2013 - Volume 47 - Issue 8 - p 727–733
doi: 10.1097/MCG.0b013e318294148d

Background and Aim: Data on outcome of patients after liver transplantation (LT) for cirrhosis due to hepatitis C virus (HCV+) alcohol are limited.

Methods and Results: Analysis from United Network for Organ sharing data set (1991 to 2010) for cirrhotics with first LT for HCV (group I, N=17,722), alcohol or alcoholic cirrhosis (AC; group II, N=9617), and alcohol+HCV (group III, N=6822). Five-year graft and patient survival for group III were similar to group I (73% vs. 69%; P=0.33 and 76% vs. 76%; P=0.87) and worse than group II (70% vs. 74%; P<0.0001 and 76% vs. 79%; P<0.0001). Cox regression analysis adjusted for recipient and donor characteristics showed (a) graft survival for group III similar to group I [hazard ratio (HR) 1.03 (95% confidence interval (CI), 0.97-1.09)] and worse than group II [HR 1.27 (95% CI, 1.19-1.35)] and (b) patient survival for group III worse than both groups I [HR 1.09 (95% CI, 1.02-1.15)] and II [HR 1.27 (95% CI, 1.19-1.36)]. In group III, graft failure was common for graft and patient loss and de novo malignancy more common compared with group I.

Conclusions: Patients undergoing LT for cirrhosis due to combined alcohol and HCV have (a) graft survival similar to patients with HCV cirrhosis and worse than AC and (b) worse patient survival compared with AC and HCV cirrhosis. Better strategies for anti-HCV treatment and screening for tumors are needed for patients undergoing LT for combined alcohol and HCV.

Departments of *Internal Medicine

Biostatistics and Sealy Center of Aging

Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX

The authors declare that they have nothing to disclose.

Reprints: Ashwani K. Singal, MD, Department of Gastroenterology and Hepatology, University of Texas Medical Branch, 301 Univ. Blvd., Galveston, TX 77555-0764 (e-mail:

Received May 30, 2012

Accepted March 15, 2013

© 2013 by Lippincott Williams & Wilkins