Predictive factors for successful liver transplants in candidates with alcoholic liver disease

Over eight thousand patients died in 1997 of end stage alcoholic liver disease because no donor organs were available. Only four thousand were more fortunate and received donor organs. The shortage of available organs makes selection of recipients one of the most controversial areas in medicine today, especially when the recipient requires a transplant due to use of alcohol. The ability to predict which candidates will be successful is critical. This study, conducted with transplant patients at Jackson Memorial Hospital, the second largest transplant hospital in the United States, attempts to identify criteria that indicates which candidate will most likely relapse and which will die.;A pilot study was conducted in 1996 by Albanese et al. using 55 patients transplanted at Jackson Memorial Hospital. The pilot study found that six months or more of abstinence was statistically significant in predicting which patients would not relapse and was also significant in reducing mortality. Having completed treatment for alcohol or drugs prior to transplant was also significant in predicting which patients would avoid relapse. Several other factors approached statistical significance: (a) lack of a support group, consisting of family, friends or an AA/NA support group, (b) presence of an Axis I or Axis II disorder, and (c) polysubstance abuse. This study is built upon the work of Albanese et al.;Patients who underwent livers transplants between 1994 and June of 1998 were eligible for participation in this study. Nine hundred and eight patients underwent transplant and 208 met the criteria for a primary or secondary diagnosis of Laennoc's Cirrohis (ALD). Charts were reviewed for the following parameters: (a) length of abstinence prior to transplant, (b) acceptance of the diagnosis of alcohol or drug dependence, (c) previous treatment for alcohol or drug abuse, (d) presence of a support group, (e) presence of poly substance abuse, (f) presence of an Axis I or II disorder, (g) willingness to sign a contract for treatment after transplant, if indicated and (h) presence of a concomitant liver disease. One hundred charts contained all information required and these were analyzed to determine correlation's between the selected factors and the dependent variables relapse and mortality.;Logistic Regression with forward stepwise entry of variables was used to statistically analyze the data. Length of abstinence, presence of support and presence of an Axis I or II disorder were all statistically significant in predicting relapse.;Length of abstinence was most significant with patients who had over six months of abstinence being 10 times less likely to relapse. Those with a source of support were five times less likely to relapse and those with an Axis I or II disorder were four times more likely to relapse.;When mortality was taken into consideration, only length of abstinence was significant. Those who had over six months of abstinence were five times less likely to die.;Future studies can build upon these finding and hopefully increase the numbers of factors that can be used to identify the potentially successful patient. With the demand for organs rising each year and the available donor organs remaining almost constant, it is critical that organs be used as judiciously and fairly as possible. Future studies may bring us another step closer to that.