Original Contribution
The American Journal of Gastroenterology (2007) 102, 1032–1041; doi:10.1111/j.1572-0241.2007.01079.x
Negative Impact of De Novo Malignancies Rather than Alcohol Relapse on Survival After Liver Transplantation for Alcoholic Cirrhosis: A Retrospective Analysis of 305 Patients in a Single Center
Jérôme Dumortier MD, PhD1,2, Olivier Guillaud1,2, Mustapha Adham1,2, Catherine Boucaud3, Bertrand Delafosse3, Yves Bouffard3, Pierre Paliard1, Jean-Yves Scoazec4 and Olivier Boillot1,2
- 1Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France
- 2Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France
- 3Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon, France
- 4Laboratoire Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Lyon, France
Correspondence: Jérôme Dumortier, MD, PhD, pavillon D, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
Received 3 August 2006; Accepted 20 November 2006.
Abstract
OBJECTIVES:
Alcoholic liver disease is a leading indication for liver transplantation (LT). The aim of this study was to evaluate long-term results and survival prognostic factors of LT in this indication from a large cohort of patients.
METHODS:
From October 1990 to October 2005, 305 consecutive patients with alcoholic cirrhosis (from 594 patients presenting with cirrhosis, i.e., 51.3%) underwent LT in our center. There were 229 men and 76 women, with a median age of 50 yr (range 30–68). Clinical and biological variables with possible prognostic value were analyzed.
RESULTS:
Global survival rate was 92.6% at 1 yr, 88.5% at 3 yr, 84.3% at 5 yr, and 73.4% at 10 yr, and was similar (P = 0.78, log-rank test) to that of patients transplanted for other cirrhosis (88.8% at 1 yr, 84.1% at 3 yr, 80.6% at 5 yr, and 74.7% at 10 yr). Recurrence of alcohol consumption was observed in 37 patients (12.1%). De novo cancer occurred in 35 patients after LT (11.5%). Univariate analysis disclosed that male gender, history of smoking, and de novo carcinoma were significant survival prognostic factors (P < 0.05, log-rank test).
CONCLUSIONS:
Our results strongly confirm that alcoholic liver disease is an excellent indication for LT, but long-term survival is reduced because of other target-organ damage of both alcohol and tobacco, especially aero-digestive malignancies, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease.
