Alcoholic patients valued for liver transplant: new predictive factors of relapse

Background and aims. The alcoholic cirrhosis is a consolidated indication to the liver transplant (OLT) and is the first indication in Europe. Ninety-five percent of patients with end-stage alcoholic liver disease has never been formally valued for liver transplant. A documented alcoholic abstinence of almost 6 months is strictly necessary in order to be included in a waiting list. It is important to underline that some factors such as age, socio-economic stability, absence of consumption of other substances have turned out to be prognosis positive factors for the maintaining of posttransplant abstinence. The object of our research is to identify new relevant predictive factors of relapse in these patients. Methods. Since 2004 to date, we have been valuing 231 men and 40 women (total 271 patients) aged 23–68, affected by liver cirrhosis, in order to set alcoholism diagnosis according to DSM-IV criteria and to monitor, as well as sustain abstinence in pre- and post-OLT. Data analysis was performed by using SPSSW 18. Results. 83.5% of patients presented alcoholic dependence diagnosis; 12.9% abuse; 2.6% active polyabuse, while just 1% of patients turned out non-drinker. The average age of first contact with alcoholic beverages was around 15; the risk consumption period was within those aged 25–27, with average consumption of 9 UA/die and maximum of 15 UA/die. Sixty-five percent of patients presented positive familiarity for alcoholism. 53.9% of the sample were smokers. 29.9% of patients consumed illicit drugs in the past; among them 9.2% came out positive to the toxicological exam. A high number of patients (78.9%) presented a stable family support, fundamental for the compliance pre- and post-OLT. The percentage of patients without scholastic failures was 48.3%. Conclusions. The relapse percentage of our sample in pre- (18.5%) and post (13.5%)-OLT is lower than the data present in literature; this can be due to the identification of new predictive factors of relapse ( positive familiarity for alcoholism, premature first contact, risk consumption years, scholastic failures) as well as to a strict monitoring with specific medical management in a specialist alcohol service. Hence, the importance of the figure of the specialist in alcoholism in transplant team.