Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis

Joel F. Karman, Pierpaolo Sileri, Donna Kamuda, Luca Cicalese, Cristiana Rastellini, Thelma E. Wiley, Thomas J. Layden, Enrico Benedetti

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background. The majority of liver transplant centers require a 6-month abstinence period before listing candidates for liver transplantation with alcoholic cirrhosis and a persistent sobriety thereafter. We attempted to identify risk factors for failure to comply with these requirements. Methods. Ninety-nine consecutive patients with alcoholic cirrhosis were referred for liver transplant evaluation between September 1996 and May 1998. The mean age was 49 years, 74% were male, and 54% were hepatitis C virus positive. To be listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently monitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the liver transplant waiting list. Detailed patient information was entered into a computerized database, and 36 discreet variables were analyzed in relation to success (patient listed and remained on the list) or failure (not listed or removed from the list based on noncompliance). Results. Forty-nine patients were successfully listed. Nineteen received a transplant, with a 95% 1-year patient and graft survival rate and 21% alcohol relapse rate after transplantation. Twenty-two patients had either medical contraindication and/or died before transplant listing. Twenty-four patients were never listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identified five significant risk factors for failure: (I) living arrangement (alone/family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluation, P=0.001; and (V) failure to accept further alcoholic rehabilitation before orthotopic liver transplantation, P=0.01. Conclusions. Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis. We identified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.

Original languageEnglish (US)
Pages (from-to)1210-1213
Number of pages4
JournalTransplantation
Volume71
Issue number9
StatePublished - May 15 2001
Externally publishedYes

Fingerprint

Alcoholic Liver Cirrhosis
Transplants
Liver
Alcohols
Liver Transplantation
Rehabilitation
Transplantation
Waiting Lists
Hematologic Tests
Graft Survival
Hepacivirus
Suicide
Alcoholism
Hospitalization
Survival Rate
Urine
Databases

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Karman, J. F., Sileri, P., Kamuda, D., Cicalese, L., Rastellini, C., Wiley, T. E., ... Benedetti, E. (2001). Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis. Transplantation, 71(9), 1210-1213.

Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis. / Karman, Joel F.; Sileri, Pierpaolo; Kamuda, Donna; Cicalese, Luca; Rastellini, Cristiana; Wiley, Thelma E.; Layden, Thomas J.; Benedetti, Enrico.

In: Transplantation, Vol. 71, No. 9, 15.05.2001, p. 1210-1213.

Research output: Contribution to journalArticle

Karman, JF, Sileri, P, Kamuda, D, Cicalese, L, Rastellini, C, Wiley, TE, Layden, TJ & Benedetti, E 2001, 'Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis', Transplantation, vol. 71, no. 9, pp. 1210-1213.
Karman JF, Sileri P, Kamuda D, Cicalese L, Rastellini C, Wiley TE et al. Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis. Transplantation. 2001 May 15;71(9):1210-1213.
Karman, Joel F. ; Sileri, Pierpaolo ; Kamuda, Donna ; Cicalese, Luca ; Rastellini, Cristiana ; Wiley, Thelma E. ; Layden, Thomas J. ; Benedetti, Enrico. / Risk factors for failure to meet listing requirements in liver transplant candidates with alcoholic cirrhosis. In: Transplantation. 2001 ; Vol. 71, No. 9. pp. 1210-1213.
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abstract = "Background. The majority of liver transplant centers require a 6-month abstinence period before listing candidates for liver transplantation with alcoholic cirrhosis and a persistent sobriety thereafter. We attempted to identify risk factors for failure to comply with these requirements. Methods. Ninety-nine consecutive patients with alcoholic cirrhosis were referred for liver transplant evaluation between September 1996 and May 1998. The mean age was 49 years, 74{\%} were male, and 54{\%} were hepatitis C virus positive. To be listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently monitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the liver transplant waiting list. Detailed patient information was entered into a computerized database, and 36 discreet variables were analyzed in relation to success (patient listed and remained on the list) or failure (not listed or removed from the list based on noncompliance). Results. Forty-nine patients were successfully listed. Nineteen received a transplant, with a 95{\%} 1-year patient and graft survival rate and 21{\%} alcohol relapse rate after transplantation. Twenty-two patients had either medical contraindication and/or died before transplant listing. Twenty-four patients were never listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identified five significant risk factors for failure: (I) living arrangement (alone/family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluation, P=0.001; and (V) failure to accept further alcoholic rehabilitation before orthotopic liver transplantation, P=0.01. Conclusions. Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis. We identified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.",
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AU - Karman, Joel F.

AU - Sileri, Pierpaolo

AU - Kamuda, Donna

AU - Cicalese, Luca

AU - Rastellini, Cristiana

AU - Wiley, Thelma E.

AU - Layden, Thomas J.

AU - Benedetti, Enrico

PY - 2001/5/15

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N2 - Background. The majority of liver transplant centers require a 6-month abstinence period before listing candidates for liver transplantation with alcoholic cirrhosis and a persistent sobriety thereafter. We attempted to identify risk factors for failure to comply with these requirements. Methods. Ninety-nine consecutive patients with alcoholic cirrhosis were referred for liver transplant evaluation between September 1996 and May 1998. The mean age was 49 years, 74% were male, and 54% were hepatitis C virus positive. To be listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently monitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the liver transplant waiting list. Detailed patient information was entered into a computerized database, and 36 discreet variables were analyzed in relation to success (patient listed and remained on the list) or failure (not listed or removed from the list based on noncompliance). Results. Forty-nine patients were successfully listed. Nineteen received a transplant, with a 95% 1-year patient and graft survival rate and 21% alcohol relapse rate after transplantation. Twenty-two patients had either medical contraindication and/or died before transplant listing. Twenty-four patients were never listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identified five significant risk factors for failure: (I) living arrangement (alone/family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluation, P=0.001; and (V) failure to accept further alcoholic rehabilitation before orthotopic liver transplantation, P=0.01. Conclusions. Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis. We identified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.

AB - Background. The majority of liver transplant centers require a 6-month abstinence period before listing candidates for liver transplantation with alcoholic cirrhosis and a persistent sobriety thereafter. We attempted to identify risk factors for failure to comply with these requirements. Methods. Ninety-nine consecutive patients with alcoholic cirrhosis were referred for liver transplant evaluation between September 1996 and May 1998. The mean age was 49 years, 74% were male, and 54% were hepatitis C virus positive. To be listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently monitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the liver transplant waiting list. Detailed patient information was entered into a computerized database, and 36 discreet variables were analyzed in relation to success (patient listed and remained on the list) or failure (not listed or removed from the list based on noncompliance). Results. Forty-nine patients were successfully listed. Nineteen received a transplant, with a 95% 1-year patient and graft survival rate and 21% alcohol relapse rate after transplantation. Twenty-two patients had either medical contraindication and/or died before transplant listing. Twenty-four patients were never listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identified five significant risk factors for failure: (I) living arrangement (alone/family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluation, P=0.001; and (V) failure to accept further alcoholic rehabilitation before orthotopic liver transplantation, P=0.01. Conclusions. Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis. We identified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.

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