Ricerc@Sapienza

Alcoholic liver disease (ALD) is one of the
main indications for liver transplantation (LT) reaching about 30% in
Europe and in the USA. According to the literature 20% > 50% of
patients experience alcohol relapse in the first 5 years after LT. With
this in mind, a program of multidisciplinary support to alcohol
misusers (MSAM) was developed by Our Unit starting from 2004 to
assist patients undergoing LT for ALD. This study aims at analyzing the relapse rate in the group of patients prospectively enrolled for MSAM
and compare with a control group transplanted from 2000 to 2003,
with no access to MSAM. We also analyzed the risk factors for alcohol
relapse and survival.
Methods: All patients with ALD transplanted from 2004 to 2013 at
our University hospital were considered for the study. All patients
underwent MSAM before and after LT. Patients with a follow-up
shorter than 6 months were excluded from the analysis. Patients
transplanted for ALD before from 2000 to 2004, with no access to
MSAM, were considered as control group. For each patient the most
important demographic, psychosocial and clinical characteristics
known to be associated with alcohol relapse were registered.
Results: A total of 69 patients underwent MSAM. Of these, 8.7%
presented alcohol relapse. Relapse risk factors were female gender
(p = 0.004), a history of alcohol withdrawal syndrome (p = 0.01),
short follow-up before LT (p = 0.004), few sessions in the alcohol unit
(p = 0.003) and short abstinence time before LT (p = 0.0007). The
MSAM group presented a significantly lower alcohol relapse rate than
the control group (8.7% vs. 27.7%; p = 0.02) despite similar demographic,
clinical and psychological characteristics. The 5-year survival
rate was higher than that of the historical group (p = 0.008).
Conclusions: This study shows that the MSAM program contributes
to alcohol relapse prevention after LT in patients transplanted for ALD
and improves 5 years survival in patients transplanted for ALD.