Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease
Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease
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DOI：
10.1002/lt.20386
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发表时间：
2005-04-01
影响因子：
4.6
通讯作者：
Pons-Romero, F
中科院分区：
文献类型：
--
作者：
Cuadrado, A;Fábrega, E;Pons-Romero, F
本研究旨在探讨酒精性肝病(ALD)原位肝移植(OLT)后酒精复发率及其对移植物和患者生存的影响，以及合并症和新发癌症的发生情况。这项研究是在我们的ALD中心进行分析和移植的54名受试者进行的，他们的随访延长到平均99.2(SD 31.7)个月(范围14-155个月)。回顾医疗记录，收集酒精消费、治疗依从性、移植物进化、排斥反应、感染、合并症、新发恶性肿瘤和其他临床事件的比率以及存活率的数据。组间比较采用Fisher‘s精确检验，生存评估采用Kaplan-Meier法。生存曲线比较采用Mantel-Cox统计量。用COX比例风险模型分析饮酒再犯的死亡风险。接受ALD移植的14名患者(25.9%)在OLT后5.0至86.9个月(中位数，47.5)恢复饮酒。有无酒精再犯与移植物排斥反应、感染、原位肝移植术后相关并发症或依从性的发生之间没有显著的关联。再饮酒患者的5年和10年生存率分别为92.9%和45.1%，而不再饮酒患者的5年和10年生存率分别为92.4%和85.5%。这些数据显示10年后再犯患者的存活率显著降低(P<；0.01，Mantel-Cox)。恢复饮酒的患者的10年存活率更低，这可能是因为死亡的频率更高，主要是癌症和心血管事件。
The aim of this study was to evaluate the rate of alcohol recidivism after orthotopic liver transplantation (OLT) for alcoholic liver disease (ALD) and its influence on the allograft and patient survival, as well as the development of comorbidities and de novo cancers. The study was performed on 54 subjects previously analyzed and transplanted in our center for ALD, whose follow-up was prolonged to a mean of 99.2 (SD 31.7) months (range, 14-155). Medical records were reviewed, and data on alcohol consumption, therapeutic compliance, graft evolution, rejection, infections, comorbidities, rates of de novo malignancies and other clinical events, and survival were collected. Comparisons between groups were performed by the Fisher's exact test, and survival was assessed by the Kaplan-Meier method. Survival curves were compared using the Mantel-Cox statistic. The risk of death resulting from alcohol recidivism was analyzed with a Cox proportional hazards model. Fourteen patients who underwent transplantation for ALD (25.9%) returned to alcohol use between 5.0 and 86.9 months after OLT (median, 47.5). There was no significant association between the presence or absence of alcohol recidivism and the occurrence of graft rejection, infections, associated comorbidities after OLT, or compliance. The 5- and 10-year survival rates for patients with alcohol recidivism were 92.9% and 45.1%, respectively, compared with 92.4% and 85.5%, respectively, for patients without alcohol recidivism. These figures show significantly lower survival rates in recidivistic patients after 10 years (P < 0.01, Mantel-Cox). The fact that patients who resumed alcohol consumption have a worse 10-year survival rate might be attributed to a higher frequency of deaths, primarily from cancer and cardiovascular events.