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Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus.

Abstract

BACKGROUND

Liver transplantation (LTx) for alcohol-related liver disease (ALD) is an accepted modality of treatment and is one of the most common indications for LTx in the United States. The present report examines the long-term patient survival, graft survival, rates of recidivism, and development of de novo cancers in this group, and compares these results with a contemporaneous group of patients who were transplanted for non-ALD indications.

METHODS

Between August 1989 and December 1992, 185 adults received LTx for ALD (group I). During the same time interval, 649 adults received LTx for non-ALD (group II). The mean follow-up time was 94+/-10.7 months for group I vs. 92+/-11 months for group II. Kaplan-Meier survival estimates and the incidence of cancers using Surveillance Epidemiologic End Result data were compared in both groups.

RESULTS

At 5 years after orthotopic LTx, the overall patient survival and graft survival for group I were 72.0% and 66.5% vs. 66.5% and 60.3% for group II, respectively. After 5 years, the patient survival and graft survival for the alcoholic group were significantly lower (P=0.001) compared to the non-alcoholic group. The rate of de novo oropharyngeal cancer and lung cancer was 25.5 times and 3.7 times higher, respectively, in ALD group compared with the general population matched for age, sex, and length of follow-up (P=0.001), whereas this was not higher in the non-ALD group. Prior pretransplant length of sobriety and alcohol rehabilitation was not associated with the rate of post-LTx rate of recidivism, which was 20%. Out of 79 deaths in group I, only 1 was attributed to recidivism and 3 to noncompliance with recidivism. The other deaths occurred from de novo cancer (n=13), posttransplant lymphoproliferative disorder (n=5), age-related complications (n=23), and other infection or miscellaneous causes (n=34).

CONCLUSIONS

Patient and graft survival past 5 years after orthotopic LTx is significantly lower for ALD for a variety of reasons (P=0.001). The rate of upper airway malignances was significantly higher in ALD patients than for non-ALD post-LTx patients and the general public. Graft loss/death related to recidivism or chronic rejection was extremely low. More attention is needed for early diagnosis of de novo cancer and prevention of cardiorespiratory and cerebrovascular complications.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Thomas E. Starzl Transplantation Institute, Department of Psychiatry, University of Pittsburgh, Pennsylvania 15213, USA.

    , , , ,

    Source

    Transplantation 70:9 2000 Nov 15 pg 1335-42

    MeSH

    Adult
    Aged
    Carcinoma, Hepatocellular
    Female
    Follow-Up Studies
    Graft Survival
    Humans
    Immunosuppressive Agents
    Liver Diseases, Alcoholic
    Liver Neoplasms
    Liver Transplantation
    Male
    Middle Aged
    Survival Rate
    Tacrolimus
    Time Factors

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11087149

    Citation

    Jain, A, et al. "Long-term Follow-up After Liver Transplantation for Alcoholic Liver Disease Under Tacrolimus." Transplantation, vol. 70, no. 9, 2000, pp. 1335-42.
    Jain A, DiMartini A, Kashyap R, et al. Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus. Transplantation. 2000;70(9):1335-42.
    Jain, A., DiMartini, A., Kashyap, R., Youk, A., Rohal, S., & Fung, J. (2000). Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus. Transplantation, 70(9), pp. 1335-42.
    Jain A, et al. Long-term Follow-up After Liver Transplantation for Alcoholic Liver Disease Under Tacrolimus. Transplantation. 2000 Nov 15;70(9):1335-42. PubMed PMID: 11087149.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus. AU - Jain,A, AU - DiMartini,A, AU - Kashyap,R, AU - Youk,A, AU - Rohal,S, AU - Fung,J, PY - 2000/11/22/pubmed PY - 2001/2/28/medline PY - 2000/11/22/entrez SP - 1335 EP - 42 JF - Transplantation JO - Transplantation VL - 70 IS - 9 N2 - BACKGROUND: Liver transplantation (LTx) for alcohol-related liver disease (ALD) is an accepted modality of treatment and is one of the most common indications for LTx in the United States. The present report examines the long-term patient survival, graft survival, rates of recidivism, and development of de novo cancers in this group, and compares these results with a contemporaneous group of patients who were transplanted for non-ALD indications. METHODS: Between August 1989 and December 1992, 185 adults received LTx for ALD (group I). During the same time interval, 649 adults received LTx for non-ALD (group II). The mean follow-up time was 94+/-10.7 months for group I vs. 92+/-11 months for group II. Kaplan-Meier survival estimates and the incidence of cancers using Surveillance Epidemiologic End Result data were compared in both groups. RESULTS: At 5 years after orthotopic LTx, the overall patient survival and graft survival for group I were 72.0% and 66.5% vs. 66.5% and 60.3% for group II, respectively. After 5 years, the patient survival and graft survival for the alcoholic group were significantly lower (P=0.001) compared to the non-alcoholic group. The rate of de novo oropharyngeal cancer and lung cancer was 25.5 times and 3.7 times higher, respectively, in ALD group compared with the general population matched for age, sex, and length of follow-up (P=0.001), whereas this was not higher in the non-ALD group. Prior pretransplant length of sobriety and alcohol rehabilitation was not associated with the rate of post-LTx rate of recidivism, which was 20%. Out of 79 deaths in group I, only 1 was attributed to recidivism and 3 to noncompliance with recidivism. The other deaths occurred from de novo cancer (n=13), posttransplant lymphoproliferative disorder (n=5), age-related complications (n=23), and other infection or miscellaneous causes (n=34). CONCLUSIONS: Patient and graft survival past 5 years after orthotopic LTx is significantly lower for ALD for a variety of reasons (P=0.001). The rate of upper airway malignances was significantly higher in ALD patients than for non-ALD post-LTx patients and the general public. Graft loss/death related to recidivism or chronic rejection was extremely low. More attention is needed for early diagnosis of de novo cancer and prevention of cardiorespiratory and cerebrovascular complications. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/11087149/Long_term_follow_up_after_liver_transplantation_for_alcoholic_liver_disease_under_tacrolimus_ L2 - http://Insights.ovid.com/pubmed?pmid=11087149 DB - PRIME DP - Unbound Medicine ER -