[Liver transplantation: which indications? which results?]

Area of Science:

• Hepatology
• Transplantation Surgery
• Addiction Medicine

Background:

• Alcoholic cirrhosis is a leading indication for liver transplantation (LT) in Western countries, accounting for 25% of procedures.
• Ethical considerations and organ scarcity necessitate strict criteria for LT in alcoholic cirrhosis patients.
• End-stage liver disease from alcoholism requires definitive treatment, with LT being the only option.

Purpose of the Study:

• To define rigorous indications for liver transplantation in patients with alcoholic cirrhosis.
• To identify contraindications and predictive factors for post-transplant outcomes.
• To evaluate the efficacy and survival rates of LT in selected alcoholic cirrhosis patients.

Main Methods:

• Assessment of patient demographics, liver dysfunction severity (Child-Pugh score), and presence of complications like ascites.
• Evaluation of extrahepatic organ failure and psychosocial factors, including a minimum 6-month preoperative abstinence period.
• Exclusion of patients with risk factors for recurrent alcoholism and non-compliance.

Main Results:

• Liver transplantation offers a satisfactory quality of life and a 5-year survival rate of approximately 65% for selected alcoholic cirrhosis patients.
• Recurrent alcohol consumption post-transplant occurs in 10-15% of cases, typically with minor effects on the liver graft.
• Less than 5% of alcoholic cirrhosis patients meet current selection criteria for LT.

Conclusions:

• Strict selection criteria for LT in alcoholic cirrhosis are effective in achieving good long-term outcomes and quality of life.
• Careful preoperative assessment, including psychosocial evaluation and abstinence verification, is crucial for successful LT.
• Avoidance of unnecessary segregation of severe alcoholic cirrhosis patients who are suitable candidates for LT is essential.