Reported alcohol relapse and associated complications following liver transplantation

The rate of return to alcohol consumption after liver transplantation is challenging to ascertain. Patients may not be asked or tested consistently and may not reliably report alcohol consumption. Additionally, when patients do return to alcohol consumption the frequency of resultant harm is unclear. We retrospectively reviewed the electronic records of all patients who received liver transplantation at our centre from 2015–01-04 to 2023–03-08. All patients with alcohol recorded as a contributing factor leading to liver transplantation were included other than those receiving a concurrent intestinal graft. Those who underwent repeat transplantation were included once from the point of their first transplant. 901 patients were reviewed. 251 (28%) patients with an alcohol aetiology were included, 6 (2%) of whom underwent retransplantation during follow-up. 70% were male and median age was 57 years (IQR 51–61). Follow up was a median of 1135 days (IQR 449–1775). 132 (53%) had documented assessment as to whether they had returned to any quantity of alcohol. Of these, 38/132 (29%) had returned to alcohol consumption with a median time to recorded relapse of 1007 days (IQR 557–1527). The cumulative incidence of return to alcohol by 5 years post-transplant was approximately 25%. Of those who were known to have returned to drinking alcohol, 15 had a record of the number of units consumed with a median of 10 units/day (IQR 4–14). Among the 38 who returned to alcohol, 19 (50%) had disturbed liver chemistry ascribed to alcohol; 9 (24%) were hospitalised from complications of alcohol use (alcoholic hepatitis, pancreatitis, trauma whilst intoxicated, alcohol withdrawal syndrome); 1 (3%) died from causes related to alcohol at a little over 3 years post-transplant. These data demonstrate that a significant proportion of patients at our centre undergoing liver transplantation with alcohol considered to be of aetiological significance returned to some form of alcohol consumption post-transplant. This was apparent despite only a little over half having documented evidence of being asked about relapse and all signing agreeing to our standard listing agreement detailing a requirement for lifelong abstinence from alcohol. Despite this frequent return to alcohol consumption in some degree, rates of allograft dysfunction, hospitalisation for alcohol, and of death from complications of alcohol were relatively low.