酒精相关性肝病肝移植术后再饮酒与生存分析

目的分析酒精相关性肝移植患者的术后复饮率及其生存情况。方法对单中心2005年4月至2013年6月期间因终末期肝病行肝移植的435例患者进行回顾性分析,其中以酒精性肝病为第一移植原因的患者13例,以酒精性肝病为次要移植原因的患者68例,分别调查术前戒酒时间、术后复饮、复饮酒量,Kaplan-Meier方法计算生存曲线。结果 435例患者平均随访时间52.2个月,以酒精性肝病为第一移植原因的患者术后复饮率高于以酒精性肝病为次要移植原因的患者(46.15%比13.24%,χ2=7.838,P=0.016)。非酒精相关性肝移植的354例患者8年生存率为81.4%;以酒精性肝病为第一移植原因13例肝移植患者8年生存率为100%;以酒精性肝病为次要移植原因的68例患者8年生存率为85.3%;三者差异无统计学意义(P=0.117)。81例酒精相关性肝移植患者移植前戒酒时间6个月与移植后再饮酒无相关。结论以酒精性肝病为第一移植原因的患者术后复饮率更高,酒精相关性肝移植患者术后有较好的远期生存。酒精相关性肝移植患者移植前戒酒时间6个月与移植后再饮酒无相关。

Alcohol relapse and survival analysis after liver transplantation for alcohol-related liver disease

Objective To analyze the rate of alcohol relapse after liver transplantation （LT）for alcohol-related liver disease （ALD）and its influence on patient’s survival in a single center. Methods This retrospective study included 435 consecutive adult recipients of a primary liver graft between 2005 and 2013 in our hospital,Among 81 cases of patients with excessive alcohol consumption before transplantation,13 had ALD as primary indication,and 68 had ALD as secondary indication with other liver related diseases as their primary indications for transplantation. Medical records were reviewed, data on alcohol consumption before and after LT,and survival were collected. Results The mean follow-up time of 435 patients was 52.2 months. After transplantation,alcohol relapse rate in patients with ALD as primary indication was higher than those with ALD as secondary indication （46.15% vs 13.24 % ）. Comparisons between groups were performed by Fisher’s exact test （P= 0.016）. The survival rates assessed by Kaplan-Meier method were 81.4% ,100% and 85.3% at 8 years for patients with ALD as primary indication,as secondary indication and without ALD,respectively. Survival curves were compared using Log Rank statistic,and no differences were found among 3 groups（P= 0.117）. Abstinence time, which was more than 6 months before LT in patients with ALD,had no influence on alcohol relapse after LT. Conclusion After transplantation,alcohol relapse rate in patients with ALD as primary indication is higher than those with ALD as secondary indication. Abstinence time,which is more than 6 months before LT in patients with ALD,has no influence on alcohol relapse after LT.