Most candidates for liver transplantation have irreversible cirrhosis caused by years of heavy alcohol consumption. Arguments against liver transplantation for alcoholics include the presumption of relapse to heavy drinking, which might damage the new liver or lead to its rejection.
Introduction. Alcoholic cirrhosis of the liver, which is characterized by severe scarring due to the heavy use of alcohol, is the major cause of end-stage liver disease. For those afflicted with cirrhosis, a liver transplant often offers the only possibility for survival.
The 1-year and 5-year actuarial survival rates following liver transplantation for patients with alcoholic liver dis- ease are 82% and 68%, respectively, in the United States and 85% and 70%, respectively, in Europe.
Most are alcohol-related
“A decade ago, I never would have told you I had seen people like this,” he said. “We currently do about 12 or 13 transplant evaluations per week, and I would say 80% of them are alcohol-related.” He added: “One could say there was an alcohol epidemic even before the pandemic.
With cadaveric donor livers in high demand, most transplant centers put patients whose liver damage stems from active alcohol use at the bottom of their priority lists — if they consider them at all.
Avoid alcohol
If your liver transplant was due to an alcohol-related disease, you must never drink alcohol again as you risk harming your transplanted liver. This also applies if alcohol was thought to have contributed to your liver disease, even if it was not the main cause.
Liver transplant can have excellent outcomes. Recipients have been known to live a normal life over 30 years after the operation.
Survival rates of 70% are reported both at 2 years and at 10 years. Alcoholic hepatitis is a precirrhotic lesion; progression to cirrhosis is observed more commonly in women, in individuals with severe disease and in those who continue to drink.
The controversy peaked in the 1990s when celebrities with drinking problems — Larry Hagman, David Crosby and Mickey Mantle — got liver transplants. More recently, British soccer star George Best received a new liver in 2002, started drinking again and died three years later.
Risks of a liver transplant
More than 9 out of every 10 people are still alive after 1 year, around 8 in every 10 people live at least 5 years, and many people live for up to 20 years or more.
This informal policy, often called "the 6-month rule," can be traced to the 1980s. The thinking was that six months of abstinence gave a patient's liver time to heal and, thus, avoid a transplant. If that didn't work, the patient would have proven they can stay sober and would not return to drinking after a transplant.
Whether you can drink alcohol after a liver transplant depends on the reason you needed a transplant. If the previous problem with your liver was caused by alcohol misuse, you are advised not to drink alcohol again.
Between 10 and 20 percent of heavy drinkers develop cirrhosis, usually after 10 or more years of drinking. Anything that damages the liver over many years can lead the liver to form scar tissue.
Alcoholic hepatitis and alcoholic cirrhosis are linked to the long-term alcohol abuse seen in alcoholics. Healthcare providers don't know why some people who drink alcohol get liver disease while others do not. Research suggests there may be a genetic link, but this is not yet clear.
Do all alcoholics get alcoholic hepatitis and eventually cirrhosis? No. Some alcoholics may suffer seriously from the many physical and psychological symptoms of alcoholism, but escape serious liver damage. Alcoholic cirrhosis is found among alcoholics about 10 to 25 percent of the time.
Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.
Most medical professionals agree. The American Medical Association (AMA) classified alcoholism as a disease in 1956 and included addiction as a disease in 1987.
On analysis of seven studies, pooled prevalence of self-reported alcohol relapse was 26.3% (18.0–36.7%) over median (range) follow-up of 6.0 (3.7–8.3) years, with annual alcohol relapse rate of 4.7% (3.0–6.4%) for any alcohol use and 2.9% (0.5–5.3%) for heavy alcohol use.
The United States performs the most liver transplants of any country, nearly 7000 per year. The second most active country is China followed by Brazil with a volume remarkably which exceeds that of any of the European countries.
People with cirrhosis in Class A have the best prognosis, with a life expectancy of 15 to 20 years. People with cirrhosis in Class B are still healthy, with a life expectancy of 6 to 10 years. As a result, these people have plenty of time to seek sophisticated therapy alternatives such as a liver transplant.
Heavy drinking can lead to pneumonia because alcoholics have lower levels of white blood cells that help fend off pneumonia. The damaged immune system cannot fight against the disease, which can cause intense chest pain, fever, painful coughing, and even death.
Overall, infections are the most frequent cause of mortality in males and females, though they are significantly higher in females. In our cohort, the main causes of mortality within the first year after transplantation were infections and surgical complications in both sexes.
The chance to be transplanted at two years from listing was 65% and the risk of death was 17%. Patients with metabolic liver disease had the highest chance of undergoing liver transplantation.
Those who don't recover may die within days. Chronic liver failure is a more gradual process. People can live with cirrhosis for months or years while waiting for a liver transplant, although the need becomes more urgent when complications, such as portal hypertension, begin to develop.