Abusive Drinking After Liver Transplantation Is Associated With Allograft Loss and Advanced Allograft Fibrosis
Abusive Drinking After Liver Transplantation Is Associated With Allograft Loss and Advanced Allograft Fibrosis
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DOI：
10.1002/lt.23762
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发表时间：
2013-12-01
影响因子：
4.6
通讯作者：
Lucey, Michael R.
中科院分区：
文献类型：
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作者：
Rice, John P.;Eickhoff, Jens;Lucey, Michael R.
在因酒精性肝病（ALD）接受肝移植的患者中，酒精复发是常见的。滥用或过度饮酒的回归可能会降低总生存率;然而，酒精使用对同种异体移植物结局和组织病理学的影响尚不明确。我们回顾了1995年1月1日至2007年12月31日期间所有以ALD为指征的肝移植病例。比较了复发酗酒患者和保持戒酒患者的同种异体移植结果和组织病理学结果。在此期间接受ALD移植的300例患者至少存活了1年，48例（16.0%）复发为临床关注的酒精使用。复发模式为10例患者（20.8%）的单一事件，22例患者（45.8%）的间歇性复发，16例患者（33.3%）的持续大量饮酒。单变量考克斯比例风险分析[风险比（HR）=2.43，95%可信区间（CI）=1.26-4.68，P=0.008]和多变量考克斯比例风险回归分析（HR=2.57，95% CI=1.32-5.00，P=0.006）显示，持续大量饮酒与同种异体移植物丢失相关。一项控制丙型肝炎病毒状态和活检时间的配对分析比较了复发饮酒患者和保持戒酒患者的同种异体移植组织病理学结果。显著脂肪变性[比值比（OR）=3.46，95% CI=1.29-9.31，P=0.01]、脂肪性肝炎（OR=6.2，95% CI=1.70-22.71，P=0.006）和晚期（3期或更高）纤维化（OR=23.18，95% CI=3.01-177.30，P=0.003）与酒精复发相关。总之，肝移植术后酒精复发（特别是大量饮酒）与移植物存活率降低和晚期移植物纤维化有关。肝移植19：1377-1386，2013。(c)2013年AASLD。
In patients who undergo liver transplantation for alcoholic liver disease (ALD), alcohol relapse is common. A return to abusive or excessive drinking likely decreases overall survival; however, the effects of alcohol use on allograft outcomes and histopathology are less well defined. We reviewed all cases of liver transplantation with ALD as an indication between January 1, 1995 and December 31, 2007. Allograft outcomes and histopathological results were compared for patients who relapsed into alcohol use and patients who maintained abstinence. Three hundred patients who underwent transplantation for ALD during this period survived at least 1 year, and 48 (16.0%) relapsed into alcohol use that came to clinical attention. The pattern of relapse was a single event for 10 patients (20.8%), intermittent relapses for 22 patients (45.8%), and continuous heavy drinking for 16 patients (33.3%). Continuous heavy drinking was associated with allograft loss in a univariate Cox proportional hazards analysis [hazard ratio (HR)=2.43, 95% confidence interval (CI)=1.26-4.68, P=0.008] and in a multivariate Cox proportional hazards regression (HR=2.57, 95% CI=1.32-5.00, P=0.006). A matched-pair analysis that controlled for the hepatitis C virus status and the time to biopsy compared the results of allograft histopathology for patients who relapsed into alcohol use and patients who maintained abstinence. Significant steatosis [odds ratio (OR)=3.46, 95% CI=1.29-9.31, P=0.01], steatohepatitis (OR=6.2, 95% CI=1.70-22.71, P=0.006), and advanced (stage 3 or higher) fibrosis (OR=23.18, 95% CI=3.01-177.30, P=0.003) were associated with alcohol relapse. In conclusion, alcohol relapse after liver transplantation (particularly heavy drinking) is associated with decreased graft survival and advanced allograft fibrosis. Liver Transpl 19:1377-1386, 2013. (c) 2013 AASLD.