Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden:: Impact of structured management on recidivism
Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden:: Impact of structured management on recidivism
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DOI：
10.1080/00365520410009591
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发表时间：
2005-02-01
影响因子：
1.9
通讯作者：
Friman, S
中科院分区：
文献类型：
--
作者：
Björnsson, E;Olsson, J;Friman, S
目标。此前在斯堪的纳维亚国家对酒精性肝病（ALD）患者的移植手术没有进行系统评价。关于酒精问题的结构化管理对ALD移植后再犯风险的影响的数据有限。材料和方法。共有103例ALD患者与对照组非酒精性肝病（NALD）患者进行比较。比较1988 ~ 1997年和1998年以后（结构化管理制度）ALD移植患者的再犯率。结果。ALD组中位随访时间为31（6 ~ 60）个月，对照组中位随访时间为37（12 ~ 63）个月。ALD组1年和5年的总生存率分别为81年和69年，非酒精组为87年和83年。ALD患者Child-Pugh C的比例（75%）高于NALD患者（44%）（p< 0.01）。32例（33%）ALD患者移植后恢复饮酒；17例患者（18%）重度饮酒者。一项多变量分析显示：性别、年龄、婚姻和就业状况、苯二氮卓类药物使用和非法药物滥用史不能预测tx后酒精复发的风险。在结构性治疗开始前移植的40例患者中有19例（48%）恢复饮酒，但在干预后的58例患者中有13例（22%）恢复饮酒（p = 0.002）。结论。ALD是肝移植的一个很好的指征，在ALD患者中也有类似的结果。移植前后酒精问题的结构化管理对于尽量减少再犯的风险很重要。
Objective. No systematic evaluation has been performed previously in the Scandinavian countries on patients transplanted for alcoholic liver disease (ALD). Data are limited on the impact of structured management of the alcohol problem on the risk of recidivism following transplantation in ALD. Material and methods. A total of 103 ALD patients were compared with a control group of patients with non-alcoholic liver disease (NALD). The recidivism rates for ALD patients transplanted between 1988 and 1997 as well as after 1998 ( institution of structured management) were compared. Results. The median follow-up was 31 ( 6 - 60) months in the ALD group and 37 ( 12 - 63) months in the control group (NS). The overall survival rates at 1- and 5 years were, respectively, 81) and 69) for the ALD group and 87) and 83) for the non-alcoholic group. The proportion of patients with Child-Pugh C (75%) was higher in ALD patients than in NALD patients (44%) ( p< 0.01). Thirty-two (33%) ALD patients resumed taking some alcohol after transplantation; 17 patients (18%) were heavy drinkers. A multivariate analysis showed that: sex, age, marital and employment status, benzodiazepine use and a history of illicit drug abuse did not predict the risk of alcohol relapse post-Tx. Nineteen out of 40 (48%) patients transplanted before the start of structured management had resumed alcohol but 13 (22%) out of 58 after this intervention ( p = 0.002). Conclusions. ALD is a good indication for liver transplantation, with similar results in the ALD patients. Structured management of the alcohol problem before and after transplantation is important in minimizing the risk of recidivism.