Transplantation for alcoholic liver disease

Liver transplantation for patients with alcoholic liver disease raises issues and controversies not seen with other indications. This is partly based on the perception that alcoholic liver disease is self induced, despite the fact that clear genetic and environmental influences exist, but also because the recipient may return to a pattern of drinking that will damage the graft. Although such medical issues should be discussed openly, uninformed debate risks undermining public confidence in the use of the donated livers and may result in fewer organ donations.

Though many recipients return to some degree of alcohol consumption after transplantation overall this is to a degree similar to that in patients grafted for other conditions. Fewer than 10% return to drinking more than 21 units per week.1 2 At five years, less than 5% of grafts are lost as a direct or indirect consequence of alcohol misuse.3 This contrasts with graft loss of 10% from recurrent hepatitis C virus infection.4

Most, if not all, transplant …