Liver transplantation and access to care for women with alcohol abuse and dependence

Background and aim: Liver transplantation is an important therapy for reducing mortality in patients with terminal alcoholic liver diseases. According to international estimate data there is a ratio of three to one between adult men and women at risk of alcohol consumption. Considering the sample of individuals with alcohol abuse and dependence evaluated for liver transplantation and then transplanted, this proportion changes. The aim of our study is to assess whether women have the same chance of cure than men in liver transplant for alcoholic cirrhosis. Material and methods: Between 2004 and 2012 we evaluated 350 patients (299 males and 51 females) aged 23–68, affected by liver cirrhosis, in order to set alcoholism diagnosis according to DSM-IV-TR criteria and to monitor as well as sustain abstinence in pre and post liver transplant. Results: Diagnosis rates of dependence were similar in the two sexes (82.3% in women vs 83.6% in men). 21.6% of women reported use of illicit drugs, compared to 42.4% of men. 81 patients were transplanted, 70 men (86.4%) and 11 women (13.6%). The rate of post-transplant mortality is 18.1% in women and 22.8% in men. Two women underwent re-transplantation without intake of alcohol. Conclusions: Our study shows that, although women with alcoholic liver cirrhosis and alcohol dependence exhibit a lower severity of the main prognostic indicators of post-transplant relapse and lower mortality, are still undervalued as candidates for diagnosis and transplant evaluation. Often the diagnosis of alcohol dependence and alcohol-related cirrhosis is only the first episode of hepatic failure or bleeding. Women bear the brunt of social judgment and are not readily available to ask for help and then to receive treatment. Although alcohol consumption in adult women has increased and it has been demonstrated higher susceptibility to organ damage than men, women with greater difficulty accessing transplant centers.