Liver Transplant Resources: Chronic Alcoholic Liver Disease
It has been known for centuries that alcohol is directly toxic to the liver. Alcoholic liver disease is a major cause of chronic liver disease and cirrhosis in the United States, and most of the civilized world. In many circumstances, patients with alcoholic liver disease also carry the diagnosis of alcoholism.
Since the inception of liver transplantation back in the early 1980s, there has been special concern for patients with alcoholic liver disease and alcoholism that are evaluated for liver transplant. The major concern both for the physicians and surgeons, as well as the general public, relates to the return of drinking after a successful liver transplant.
For many years, most liver transplant programs have evaluated the patients with alcohol related liver disease, but have use what is called the “six month rule” in evaluating these patient. The six month rule states that the patients with alcohol related liver disease most first be abstinent from all alcoholic beverages for minimum of six months prior to being evaluated for liver transplant. During the six months, they need to participate in an active relapse prevention program, such as Alcoholics Anonymous or some other alcohol rehab program. The patients that do not satisfy the six month rule will not be deemed suitable for liver transplant.
We have taken a slightly different approach to the six month rule. Researching it extensively, there was no clinical research that indicates that being abstinent from alcohol for six months or greater will predict alcohol use after transplant. We have developed a strategy to carefully evaluate each patient on a case by case basis, and determine whether or not they need a period of abstinence prior to liver transplant. We have worked diligently putting a multispecialty team together including hepatologists, liver transplant surgeons, liver transplant social workers with experience in substance abuse counseling, psychiatry, as well as specialist in addiction medicine.
Within this framework, we have developed a dedicated team to evaluate such patients with alcoholism and alcoholic liver disease. Working very closely with a number of alcohol rehabilitation centers around the state and region, we have been able to successfully transplant patients with alcohol related liver disease while phasing out the six month rule. This has allowed us to evaluate more patients with alcohol related liver disease that otherwise would not have received a chance at receiving a liver transplant. The percent of patients returning to abusive alcohol use is exquisitely low.