Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing

Background/Aims: The aim of our study was to evaluate the proportion of patients with severe alcoholic cirrhosis who would need orthotopic liver transplantation (OLT) and to determine the optimal delay to evaluate an abstinent patient for transplantation. Methods: Survival without OLT, improvement in liver function and need for OLT were studied in all patients admitted in 1997 for a first episode of Child–Pugh C alcoholic cirrhosis. Results: Twenty-six percent (19/74) of patients died during the initial hospitalization. The cumulative survival rates after 6 months and 1, 2 and 3 years were 56, 36, 35 and 24%, respectively. One liver transplantation (1.3%, 95% confidence interval 0.0–3.9) was performed for persisting liver failure despite abstinence. Improvement of the Child–Pugh score was observed within 3 months in 66% of the abstinent patients. OLT was indicated in four patients without liver improvement despite abstinence, but was contraindicated in three. Conclusions: Only a few patients with severe alcoholic cirrhosis undergo OLT, since most of them do not stop drinking and/or die soon, and those becoming abstinent often improve their liver function. OLT should be considered when improvement in liver function is lacking after 3 months of abstinence