Might physicians be restricting access to liver transplantation for patients with alcoholic liver disease?

In France, the most common cause of cirrhosis is excessive alcohol consumption. Post-transplant survival rates in patients with alcoholic liver disease (ALD) are at least as good as those seen with other indications. However, fewer of these patients are found on the waiting list. To understand the reasons for this discrepancy, it was decided to examine physicians' attitudes concerning the allocation of deceased donor liver allografts.

Using a standardized postal questionnaire, 1739 physicians were asked to allocate 100 liver transplants to two competing groups of patients who were equivalent except for the cause of their cirrhosis (i.e. alcohol-related or primary biliary cirrhosis). A composite score was then used to assess their attitude regarding the behavior of alcoholics and their responsibility for their illness.

Among the 475 respondents (response rate: 27.3%), 55.2% allocated fewer than 50 transplants to ALD patients. This lower rate was independently associated with factors such as being a general practitioner (odds ratio [OR]=3.2, 95% confidence interval [95%CI]=1.8-5.9), a misinterpretation of ALD patients being equivalent to others (OR=1.8, 95%CI=1.1-3.0) or unfavorable attitudes regarding alcoholics (OR=4.0, 95%CI=1.7-9.5, to OR=126.8, 95%CI=34.0-472.1).

Greater information and education of physicians may improve access to liver transplantation for ALD patients.