Eighty-four patients with the diagnosis of end-stage alcoholic liver arate analysis of high-risk patients with poly-drug use disease underwent liver transplantation from April, 1986 to July, (n Γ
15, alcohol recidivism 8/15, 53%) and the remaining 1994. A diagnosis of alcohol dependence was established by clinical low-risk group of purely alcohol dependent patients (n impression by the primary author based upon the American Psychi- atric Association's Diagnostic and Statistical Manual criteria. 15 Γ
48, alcohol recidivism 5/48, 10%) found no combination Sixty-three of these patients (75% long-term survival) lived longer of variables was predictive of abstinence in either group.
than 18 months and were included in a cohort of patients who were
The length of pretransplantation abstinence is a relaevaluated for a number of pretransplantation variables and a variety tively poor predictor of posttransplantation abstinence.
of posttransplantation clinical outcomes. The 21 (21/84, 25%) pa-Variables of comorbid substance use, social function, tients that were excluded from this analysis did not imbibe alcohol and possibly family history are more predictive in conas per our monitoring protocol. Follow-up was 100% with a mean junction with our standard criteria and might be useful follow-up of 49.3 { 21 months.
as tools in evaluating liver transplantation candidates
All candidates underwent an extensive pretransplantation evaluawhose primary diagnosis is alcohol-induced cirrhosis. tion, including a medical evaluation (ie, investigation for terminal or complicating cardiac, pulmonary, and renal diseases). 16 Candidates (HEPATOLOGY 1997;25:1469-1477.) were evaluated for adequate psycho-social support and the likelihood of sustained abstinence from ethanol after transplantation. The general, pretransplantation, psycho-social inclusion criteria for trans-Abbreviations: DUI, driving a vehicle under the influence of alcohol; ROC curve, receiverplantation included the presence of the following: 1) patient recognioperating characteristic curve; DRUG-USE, recipient history of any illicit drug use (yes Γ
tion of their alcoholism as a significant problem (ie, patient's verbal 1, no Γ
0); LIFE-INS, recipient history of an active life insurance at the time of transplantation (yes Γ
1, no Γ
0); ETOH-SIS, number of alcoholic sisters of the recipient (numeric statements during the course of evaluation), 2) a domicile, 3) a previvalue); PRE-TRANS-ABS, length of pretransplantation abstinence of the recipient (months, ous occupation, and 4) at least one close personal relationship for numeric value). psycho-social support before and following transplantation. 17 Defini-From the Rush-Presbyterian-