barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
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BARCELONA . SPAIN<br />
144 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 145<br />
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012<br />
Combined alcoholism and HCV infection are common among patients under evaluation <strong>for</strong> liver<br />
transplantation and histological changes <strong>of</strong> HCV infection are also common in post transplant biopsies<br />
from <strong>the</strong>se patients. In addition, <strong>the</strong> hepatocellular carcinoma may develop on top <strong>of</strong> cirrhosis, and in this<br />
case <strong>the</strong> candidate’s management is based on <strong>the</strong> accepted criteria <strong>for</strong> liver transplantation in <strong>the</strong> presence<br />
<strong>of</strong> hepatocellular carcinoma. Co-morbidities that might limit <strong>the</strong> potential <strong>for</strong> successful operation - such<br />
as pancreatitis, central and peripheral neuropathy, heart disease, myopathy, renal insufficiency or poor<br />
nutritional status should be assessed during <strong>the</strong> candidate’s management.<br />
Although only about 10% <strong>of</strong> alcoholic liver allograft recipients resume drinking in an abusive or dependent<br />
fashion, ef<strong>for</strong>ts to restrict <strong>the</strong> risks <strong>of</strong> relapse and graft loss are mandatory. Histological changes are usual<br />
mild and liver damage is slow to develop after alcohol relapse but fatty changes and fibrosis are more<br />
severe in patients who are heavy drinkers than in occasional drinkers and abstainers. Whe<strong>the</strong>r due to a<br />
direct effect on <strong>the</strong> graft or indirectly because <strong>of</strong> noncompliance or damage to o<strong>the</strong>r organs, <strong>the</strong> effect <strong>of</strong><br />
histological recurrence due to alcohol recidivism is much less than that seen with some o<strong>the</strong>r indications,<br />
notably with hepatitis C virus (HCV) infection.<br />
Alcoholic patients experience fewer episodes <strong>of</strong> acute cellular rejection after liver transplantation than<br />
patients transplanted <strong>for</strong> o<strong>the</strong>r reasons and chronic ductopenic rejection is also very uncommon. Conversely,<br />
cardiovascular complications and infections are common after liver transplantation <strong>for</strong> alcoholic liver disease<br />
as well as <strong>the</strong> development <strong>of</strong> de novo malignancies.<br />
Lastly, <strong>the</strong> quality <strong>of</strong> life and employment levels appear similar or even better between patients transplanted<br />
<strong>for</strong> alcoholic and non-alcoholic liver disease, whereas <strong>the</strong> compliance <strong>of</strong> such patients is still under<br />
discussion despite no difference between patients with or without alcohol relapse concerning compliance<br />
with medication, incidence <strong>of</strong> rejection or adherence to check-ups have been reported.<br />
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